MEDICARE: DR. GODWIN OBINNA UZOMBA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	200000152	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TRICARE	OTHER		582305218-GROUP #
2	014KK	OTHER	NC	BCBS NC-GROUP #
3	AETNA	OTHER		7715252-PPO
4	UNITED HEALTHCARE	OTHER		2279397-INDIVIDUAL
5	AETNA	OTHER		3072946-HMO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MAMSI	OTHER		2104818
8	1277F	OTHER	NC	BCBS NC-INDIVIDUAL #
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDCOST	OTHER		C6405
11	582305218	OTHER	NC	BCBS SC - PINEVILLE
12	582305218001	OTHER	SC	BCBS SC-ROCK HILL
13	582305218002	OTHER	SC	BCBS SC - LANCASTER

General Provider Information

NPI Number	:	1659376051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GODWIN OBINNA UZOMBA M.D.

Provider Business Mailing Address
First Line	:	4456 CENTRAL AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5702
Country	:	US
Telephone Number	:	980-299-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4456 CENTRAL AVE
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5702
Country	:	US
Telephone Number	:	980-299-0023
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	08/04/2019

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