Healthcare Provider Details

I. General information

NPI: 1285697458
Provider Name (Legal Business Name): NNEOMA A UGORJI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NNEOMA A EJIMOFOR M.D.

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 W LITTLE CREEK RD
NORFOLK VA
23505
US

IV. Provider business mailing address

924 W LITTLE CREEK RD
NORFOLK VA
23505-2024
US

V. Phone/Fax

Practice location:
  • Phone: 757-440-0719
  • Fax: 757-440-7981
Mailing address:
  • Phone: 757-440-0719
  • Fax: 757-440-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39405
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52779
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number054685
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0061942
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101236389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: