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General NPI Number Information
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NPI Number | 1821076183
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Entity Type | Individual
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Provider Name | IFEANYI IFEOMA MOMODU M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/06/2006
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 1638 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3424
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Country | US
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Telephone | 910-615-6949
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Fax | 910-615-9761
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Provider Business Mailing Address
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Address Line | 1638 OWEN DRIVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28304
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Country | US
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Telephone | 301-437-9373
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Fax | 910-615-5681
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2008-01217
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD28234
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2008-01217
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License Number State | NC
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