Healthcare Provider Details

I. General information

NPI: 1437905304
Provider Name (Legal Business Name): CHICHETARAM RUTH MAMAH MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. CHICHETARAM RUTH OTU

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 11/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF TENNESSEE, 920 MADISON AVENUE SUITE 447
MEMPHIS TN
38163
US

IV. Provider business mailing address

7 ST ANDREWS CLOSE
IPSWICH SUFFOLK
IP45SJ
GB

V. Phone/Fax

Practice location:
  • Phone: 901-448-5814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: