Healthcare Provider Details

I. General information

NPI: 1942568233
Provider Name (Legal Business Name): UZOMA O ANABA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 E APPLE ST 2ND FLOOR
DAYTON OH
45409-2902
US

IV. Provider business mailing address

5726 BLACKHAWK FOREST DR
WESTERVILLE OH
43082-9222
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2866
  • Fax:
Mailing address:
  • Phone: 614-325-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number68659
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number131344
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: