Provider Demographics
NPI:1225557648
Name:EZIEME, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:EZIEME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPINNAKER CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-9430
Mailing Address - Country:US
Mailing Address - Phone:818-640-4148
Mailing Address - Fax:
Practice Address - Street 1:905 SPINNAKER CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-9430
Practice Address - Country:US
Practice Address - Phone:818-640-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver