Healthcare Provider Details

I. General information

NPI: 1649251125
Provider Name (Legal Business Name): EMEKA MICHAEL EZIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 NEW HOPE RD STE 7
PRINCETON WV
24740-2265
US

IV. Provider business mailing address

PO BOX 755
MORGANTOWN WV
26507-0755
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-7200
  • Fax: 304-425-5813
Mailing address:
  • Phone: 304-285-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number200101198
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36425
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number200101198
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: