=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821358870
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHIOMA ANTONIA IHUNNAH ANJOU M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2012
-----------------------------------------------------
Last Update Date | 07/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 ALVORD PARK RD BLDG B
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-496-0455
-----------------------------------------------------
Fax | 860-482-7513
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 ALVORD PARK RD BLDG B
-----------------------------------------------------
City | TORRINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06790-3493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-496-0455
-----------------------------------------------------
Fax | 860-482-7513
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | LP02455
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | LP02455
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 061438
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------