Provider Demographics
NPI:1225222300
Name:OBIORA, IFEANYI GODWIN (ETC)
Entity Type:Individual
Prefix:
First Name:IFEANYI
Middle Name:GODWIN
Last Name:OBIORA
Suffix:
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DRUMMOND PLAZA OFFICE PARK
Mailing Address - Street 2:SUIT 3103
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5745
Mailing Address - Country:US
Mailing Address - Phone:302-366-7400
Mailing Address - Fax:302-366-7500
Practice Address - Street 1:1423 CAPITAL TRAIL
Practice Address - Street 2:SUIT 3103
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5745
Practice Address - Country:US
Practice Address - Phone:302-366-7400
Practice Address - Fax:302-366-7500
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2007603652332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies