Provider Demographics
NPI:1073776563
Name:NWOSU, MATTHEW CHIKE (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHIKE
Last Name:NWOSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:94 SONGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3426
Mailing Address - Country:US
Mailing Address - Phone:860-324-0688
Mailing Address - Fax:
Practice Address - Street 1:982 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-1913
Practice Address - Country:US
Practice Address - Phone:203-696-3260
Practice Address - Fax:203-696-3269
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52117207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
52117OtherCT STATE LICENSE
FN3949281OtherDEA
C00383Medicare Oscar/Certification