Healthcare Provider Details

I. General information

NPI: 1811317886
Provider Name (Legal Business Name): PAUL NWEZE MADUBUONWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAUL NWEZE MADUBUONWU MD

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FOSTER PLZ 501 HOLIDAY DRIVE
PITTSBURGH PA
15220-2749
US

IV. Provider business mailing address

501 HOLIDAY DRIVE FOSTER PLAZA 4
PITTSBURGH PA
15220
US

V. Phone/Fax

Practice location:
  • Phone: 662-745-6611
  • Fax: 662-745-9994
Mailing address:
  • Phone: 662-745-6611
  • Fax: 662-745-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number900-L
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: