Healthcare Provider Details

I. General information

NPI: 1598798662
Provider Name (Legal Business Name): DR. IKECHI C. NNAWUCHI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 31ST ST NW SUITE 536
WASHINGTON DC
20007-4403
US

IV. Provider business mailing address

1054 31ST ST NW SUITE 536
WASHINGTON DC
20007-4403
US

V. Phone/Fax

Practice location:
  • Phone: 202-570-4590
  • Fax: 202-318-0245
Mailing address:
  • Phone: 202-570-4590
  • Fax: 202-318-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0102092
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101236132
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0102092
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD035068
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: