Healthcare Provider Details

I. General information

NPI: 1992901409
Provider Name (Legal Business Name): UZOMA N OBUEKWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: UZOMA N NWANKWOR MD

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 EUCLID AVE
BRISTOL VA
24201-3609
US

IV. Provider business mailing address

2001 EUCLID AVE
BRISTOL VA
24201-3609
US

V. Phone/Fax

Practice location:
  • Phone: 276-644-4433
  • Fax: 276-644-4434
Mailing address:
  • Phone: 276-644-4433
  • Fax: 276-644-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46386
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101244053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: