Healthcare Provider Details

I. General information

NPI: 1851916670
Provider Name (Legal Business Name): ONYINYECHI CHIDOMERE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/20/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E STE 5P
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

VCUHS GMEA BOX 980257 RICHMOND, VA 23298-0257
RICHMOND VA
23298-0509
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6321
  • Fax:
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number330311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: