Healthcare Provider Details

I. General information

NPI: 1790978864
Provider Name (Legal Business Name): CHINONYEREM VERONICA ENYINNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 GOOD LUCK RD STE 10
LANHAM MD
20706-3502
US

IV. Provider business mailing address

111 N 9TH ST UNIT 519
PHILADELPHIA PA
19107-2460
US

V. Phone/Fax

Practice location:
  • Phone: 240-965-4413
  • Fax:
Mailing address:
  • Phone: 856-745-3257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD432569
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD83677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: