Provider Demographics
NPI:1003032855
Name:EZE, CHINYERE NGOZI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHINYERE
Middle Name:NGOZI
Last Name:EZE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHINYERE
Other - Middle Name:NGOZI
Other - Last Name:MUFORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11750 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2907
Mailing Address - Country:US
Mailing Address - Phone:240-419-3865
Mailing Address - Fax:
Practice Address - Street 1:11750 BUSINESS PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2907
Practice Address - Country:US
Practice Address - Phone:240-419-3865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004111363AM0700X
DCPA030649363AM0700X
VA0110003552363AM0700X
FL5103548363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCA1000041OtherCDS
FL5103548OtherSTATE LICENSURE
MDC0004111OtherSTATE LICENSE
VA0110003552OtherSTATE LICENSE
DCPA030649OtherSTATE LICENSE