Healthcare Provider Details

I. General information

NPI: 1730448416
Provider Name (Legal Business Name): ANENE UKAIGWE MB;BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE MD

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 03/27/2021
Certification Date: 03/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

3100 MACCORKLE AVE SE STE 300
CHARLESTON WV
25304-1223
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT201553
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number64966
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.141003
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number29894
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: