MEDICARE: DR. IFEANYI NWANESHIUDU 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	208600000X	Surgery Physician	C70003460	DE
2	2083X0100X	Occupational Medicine Physician	D0078360	MD

General Provider Information

NPI Number	:	1336273911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFEANYI NWANESHIUDU M.D.

Provider Business Mailing Address
First Line	:	518 S CAMP MEADE RD STE 1
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2766
Country	:	US
Telephone Number	:	443-410-3325
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 S CAMP MEADE RD STE 1
Second Line	:
City	:	LINTHICUM HEIGHTS
State	:	MD
Zip	:	21090-2766
Country	:	US
Telephone Number	:	267-241-5100
Fax Number	:

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

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	01/29/2020

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