Healthcare Provider Details

I. General information

NPI: 1770556847
Provider Name (Legal Business Name): OBIOMA IRO-NWOKEUKWU M.D..
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 CHEW AVE
PHILADELPHIA PA
19119-2002
US

IV. Provider business mailing address

6613 CHEW AVE
PHILADELPHIA PA
19119-2002
US

V. Phone/Fax

Practice location:
  • Phone: 215-848-1166
  • Fax: 215-842-0224
Mailing address:
  • Phone: 215-848-1166
  • Fax: 215-842-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD063864L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD063864L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD063864L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: