Healthcare Provider Details

I. General information

NPI: 1679929715
Provider Name (Legal Business Name): CHUKWUELOKA OBIONWU JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2016
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MASSACHUSETTS AVENUE BUILDING E23
CAMBRIDGE MA
02139-4307
US

IV. Provider business mailing address

77 MASSACHUSETTS AVENUE BUILDING E23
CAMBRIDGE MA
02139-4307
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-4481
  • Fax: 617-258-0884
Mailing address:
  • Phone: 617-253-4481
  • Fax: 617-258-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number283078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: