1619268554 NPI number — DR. CHINEKWU OZIOMA ANYANWU MD

Table of content: DR. CHINEKWU OZIOMA ANYANWU MD (NPI 1619268554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619268554 NPI number — DR. CHINEKWU OZIOMA ANYANWU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANYANWU
Provider First Name:
CHINEKWU
Provider Middle Name:
OZIOMA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619268554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
213 S JEFFERSON ST STE 1006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24011-1713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-224-5715
Provider Business Mailing Address Fax Number:
540-224-5684

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 RIVERSIDE CIR
Provider Second Line Business Practice Location Address:
DEPT OF NEUROLOGY
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24016-4955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-224-5170
Provider Business Practice Location Address Fax Number:
540-985-9612
Provider Enumeration Date:
04/26/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  MD039225 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 0101251560 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)