MEDICARE: NWAMAKA ADAOBI EZEDINMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	R0567	TX

General Provider Information

NPI Number	:	1184970097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NWAMAKA ADAOBI EZEDINMA M.D.

Provider Business Mailing Address
First Line	:	4000 SPENCER HWY
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7508 CYPRESS CREEK PKWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-5806
Country	:	US
Telephone Number	:	281-440-8090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2012
Last Update Date	:	03/17/2022

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