Provider Demographics
NPI:1043246424
Name:MOEMEKA, ANGELA NNEBUCHI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:NNEBUCHI
Last Name:MOEMEKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:NNEBUCHI
Other - Last Name:EMEJULU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:165 E. STATE HIGHWAY 121, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4237
Mailing Address - Country:US
Mailing Address - Phone:972-325-2005
Mailing Address - Fax:972-325-4175
Practice Address - Street 1:165 E. STATE HIGHWAY 121, SUITE 110
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4237
Practice Address - Country:US
Practice Address - Phone:972-325-2005
Practice Address - Fax:972-325-4175
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045322208000000X
PAMD423227208000000X
TXQ5495208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001453224Medicaid
CT370001714Medicare PIN