Provider Demographics
NPI:1245239136
Name:ACHUKO, MAUREEN NGOZI (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:NGOZI
Last Name:ACHUKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4433
Mailing Address - Country:US
Mailing Address - Phone:910-484-8114
Mailing Address - Fax:910-484-1564
Practice Address - Street 1:557 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4433
Practice Address - Country:US
Practice Address - Phone:910-484-8114
Practice Address - Fax:910-484-1564
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200481207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131R0Medicaid
NC2006051Medicare ID - Type Unspecified
NCH09698Medicare UPIN