1003602103 NPI number — MRS. CHIDINMA THERESA EZIDIEGWU M.D.

Table of content: MRS. CHIDINMA THERESA EZIDIEGWU M.D. (NPI 1003602103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003602103 NPI number — MRS. CHIDINMA THERESA EZIDIEGWU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EZIDIEGWU
Provider First Name:
CHIDINMA
Provider Middle Name:
THERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHUKWULEBE
Provider Other First Name:
CHIDINMA
Provider Other Middle Name:
THERESA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003602103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AIKEN REGIONAL MEDICAL CENTERS
Provider Second Line Business Mailing Address:
302 UNIVERSITY PARKWAY
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-842-0436
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AIKEN REGIONAL MEDICAL CENTERS
Provider Second Line Business Practice Location Address:
302 UNIVERSITY PARKWAY
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-842-0436
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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