Provider Demographics
NPI:1073674545
Name:NWOKOLO NWANGWU, CHIOMA U (MD)
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:U
Last Name:NWOKOLO NWANGWU
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 1:385 MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:203-931-1073
Mailing Address - Fax:203-931-1145
Practice Address - Street 1:385 MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516
Practice Address - Country:US
Practice Address - Phone:203-931-1073
Practice Address - Fax:203-931-1145
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G37344Medicare UPIN
110008208Medicare ID - Type Unspecified