Healthcare Provider Details

I. General information

NPI: 1578573457
Provider Name (Legal Business Name): CHUKWUMA OBI ONYEWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9841 GREENBELT RD STE 208
LANHAM MD
20706-6270
US

IV. Provider business mailing address

9841 GREENBELT RD STE 208
LANHAM MD
20706-6270
US

V. Phone/Fax

Practice location:
  • Phone: 240-786-1001
  • Fax: 240-786-1002
Mailing address:
  • Phone: 240-786-1001
  • Fax: 240-786-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberC1-0007073
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD0065933
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD034554
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0101235566
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: