Provider Demographics
NPI:1225343825
Name:MARYLAND COLORECTAL SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:MARYLAND COLORECTAL SPECIALISTS, P.A.
Other - Org Name:CHUKWUMA ANYADIKE, M.D., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADWOA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYADIKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:410-751-1387
Mailing Address - Street 1:193 STONER AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5782
Mailing Address - Country:US
Mailing Address - Phone:410-751-1387
Mailing Address - Fax:410-871-0603
Practice Address - Street 1:193 STONER AVE
Practice Address - Street 2:STE 130
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5782
Practice Address - Country:US
Practice Address - Phone:410-751-1387
Practice Address - Fax:410-871-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070668208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD231801600Medicaid