MEDICARE: VICTOR A NWACHUKU MD PC

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	207V00000X	Obstetrics & Gynecology Physician	2000254	NM
2	176B00000X	Midwife	R33612	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	850480646	OTHER	NM	TAX ID #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538165238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR A NWACHUKU MD PC

Provider Business Mailing Address
First Line	:	1618 E PINE ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061
Country	:	US
Telephone Number	:	575-388-1561
Fax Number	:	575-388-9952

Provider Business Practice Location Address
First Line	:	1618 E PINE ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061
Country	:	US
Telephone Number	:	575-388-1561
Fax Number	:	575-388-9952

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/03/2021

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Directions to “ VICTOR A NWACHUKU MD PC” Practice Location

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