Provider Demographics
NPI:1255498754
Name:MAIDOH, GREGORY CHUKWUEMEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHUKWUEMEKA
Last Name:MAIDOH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:855 BELANGER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4463
Mailing Address - Country:US
Mailing Address - Phone:985-876-9113
Mailing Address - Fax:985-868-9336
Practice Address - Street 1:855 BELANGER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4463
Practice Address - Country:US
Practice Address - Phone:985-876-9113
Practice Address - Fax:985-868-9336
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-05-01
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Provider Licenses
StateLicense IDTaxonomies
LA11345R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG14547Medicare UPIN
LA5W452CF88Medicare PIN