Healthcare Provider Details

I. General information

NPI: 1316632656
Provider Name (Legal Business Name): CHRISTOPHER IMOKHUEDE ESEZOBOR MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 05/30/2024
Certification Date: 04/11/2023
Deactivation Date: 10/11/2023
Reactivation Date: 05/30/2024

III. Provider practice location address

601 CHILDRENS LN EASTERN VIRGINIA MEDICAL SCHOOLPROGRAM
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDRENS LN EASTERN VIRGINIA MEDICAL SCHOOL PROGRAM
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7272
  • Fax:
Mailing address:
  • Phone: 757-668-9994
  • 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: