Healthcare Provider Details

I. General information

NPI: 1013303197
Provider Name (Legal Business Name): CHINEDU MADU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 MARK CENTER DR STE 150
ALEXANDRIA VA
22311-1843
US

IV. Provider business mailing address

2901 TELESTAR CT STE 300
FALLS CHURCH VA
22042-1263
US

V. Phone/Fax

Practice location:
  • Phone: 703-751-8111
  • Fax: 703-751-1105
Mailing address:
  • Phone: 703-591-1688
  • Fax: 703-591-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number0101277547
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101277547
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: