Healthcare Provider Details

I. General information

NPI: 1003279399
Provider Name (Legal Business Name): CHIOMA UDEMGBA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR STE 240
SAN ANTONIO TX
78229-4849
US

IV. Provider business mailing address

1430 TULANE AVE # SL-50
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 210-644-2100
  • Fax:
Mailing address:
  • Phone: 504-988-1332
  • Fax: 504-988-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number20674
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD048479
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU8015
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU8015
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD048479
License Number StateDC
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberU8015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: