Provider Demographics
NPI:1063676138
Name:ASOMUGHA, CHISARAOKWU NGOZI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHISARAOKWU
Middle Name:NGOZI
Last Name:ASOMUGHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CEDAR STREET
Mailing Address - Street 2:PO BOX 208088 1E-61 SHM ROBERT WOOD CLINICAL SCHOLARS
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8088
Mailing Address - Country:US
Mailing Address - Phone:203-785-7337
Mailing Address - Fax:
Practice Address - Street 1:789 HOWARD AVENUE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520
Practice Address - Country:US
Practice Address - Phone:203-785-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046476208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics