Healthcare Provider Details

I. General information

NPI: 1831483783
Provider Name (Legal Business Name): CHIOMA A NJOKU PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 MILLTOWN RD
WILMINGTON DE
19808
US

IV. Provider business mailing address

522 N HICKORY AVE
BEL AIR MD
21014-3229
US

V. Phone/Fax

Practice location:
  • Phone: 302-463-6542
  • Fax:
Mailing address:
  • Phone: 410-638-5333
  • Fax: 410-638-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003890
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0001133
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: