MEDICARE: MR. CHUKWUDI CHIGBOMKPA ODOH

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	374U00000X	Home Health Aide	HHA6175	DC

General Provider Information

NPI Number	:	1760884456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHUKWUDI CHIGBOMKPA ODOH

Provider Business Mailing Address
First Line	:	702 OGLETHORPE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2735
Country	:	US
Telephone Number	:	240-423-7782
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 OGLETHORPE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2735
Country	:	US
Telephone Number	:	240-423-7782
Fax Number	:

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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Directions to “ MR. CHUKWUDI CHIGBOMKPA ODOH ” Practice Location

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