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General NPI Number Information
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NPI Number | 1659229102
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Entity Type | Individual
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Provider Name | INNOCENT ONYEBUCHI IDEMILI
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Gender | Male
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 411 BRANCHWAY RD STE 109
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3034
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Country | US
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Telephone | 804-901-0053
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Fax | 804-509-0514
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Provider Business Mailing Address
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Address Line | 411 BRANCHWAY RD STE 109
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3034
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Country | US
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Telephone | 804-901-0053
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Fax | 804-509-0514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10042242
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License Number State | OR
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