Provider Demographics
NPI:1073939658
Name:IFECHUKWU, CHINYERE I
Entity Type:Individual
Prefix:
First Name:CHINYERE
Middle Name:I
Last Name:IFECHUKWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13840 CASTLE BLVD
Mailing Address - Street 2:APT .203
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7384
Mailing Address - Country:US
Mailing Address - Phone:301-890-0750
Mailing Address - Fax:301-890-0750
Practice Address - Street 1:13840 CASTLE BLVD
Practice Address - Street 2:APT. 203
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7384
Practice Address - Country:US
Practice Address - Phone:301-890-0750
Practice Address - Fax:301-890-0750
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant