Healthcare Provider Details

I. General information

NPI: 1306918123
Provider Name (Legal Business Name): KINGSLEY CHUKS UGOCHUKWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 LAKESTONE COMMONS AVENUE ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC
FUQUAY-VARINA NC
27526-6972
US

IV. Provider business mailing address

PO BOX 517 ANGIER PEDIATRICS AND ADULT MEDICAL CENTER, PLLC
FUQUAY-VARINA NC
27526-0512
US

V. Phone/Fax

Practice location:
  • Phone: 919-577-0481
  • Fax: 919-577-0512
Mailing address:
  • Phone: 919-577-0481
  • Fax: 919-577-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200400088
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: