MEDICARE: DR. CHINENYE IHEME 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	208000000X	Pediatrics Physician	76465	GA
2	208000000X	Pediatrics Physician	MD465458	PA

General Provider Information

NPI Number	:	1598102865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHINENYE IHEME M.D.

Provider Business Mailing Address
First Line	:	2000 PROFESSIONAL WAY STE 200
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4093
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S STATE RD STE 210
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-1243
Country	:	US
Telephone Number	:	610-623-9080
Fax Number	:

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/16/2023

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Directions to “ DR. CHINENYE IHEME M.D.” Practice Location

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