Healthcare Provider Details

I. General information

NPI: 1497140974
Provider Name (Legal Business Name): CHINWEOKE OGOMEGBUNAM NWACHUKWU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHINWEOKE OGOMEGBUNAM NWANKWO M.D.

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

201 DEFENSE HWY STE 100
ANNAPOLIS MD
21401-8902
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD85790
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: