Healthcare Provider Details

I. General information

NPI: 1225222300
Provider Name (Legal Business Name): IFEANYI GODWIN OBIORA ETC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 CAPITAL TRAIL SUIT 3103
NEWARK DE
19711-5745
US

IV. Provider business mailing address

DRUMMOND PLAZA OFFICE PARK SUIT 3103
NEWARK DE
19711-5745
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-7400
  • Fax: 302-366-7500
Mailing address:
  • Phone: 302-366-7400
  • Fax: 302-366-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2007603652
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: