MEDICARE: IFEOMA CYNTHIA NWUGBANA 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	2084P0804X	Child & Adolescent Psychiatry Physician	R8631	TX

General Provider Information

NPI Number	:	1760823009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFEOMA CYNTHIA NWUGBANA M.D.

Provider Business Mailing Address
First Line	:	2700 RESEARCH FOREST DR STE 130
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4252
Country	:	US
Telephone Number	:	281-528-4226
Fax Number	:	281-419-0921

Provider Business Practice Location Address
First Line	:	2700 RESEARCH FOREST DR STE 130
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4252
Country	:	US
Telephone Number	:	281-528-4226
Fax Number	:

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

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	02/13/2020

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