Provider Demographics
NPI:1275869737
Name:IGWE, BENJAMIN CHUKWUMA (PT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CHUKWUMA
Last Name:IGWE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23000 MOAKLEY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2915
Mailing Address - Country:US
Mailing Address - Phone:301-475-6507
Mailing Address - Fax:301-475-6507
Practice Address - Street 1:23000 MOAKLEY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2915
Practice Address - Country:US
Practice Address - Phone:301-475-6507
Practice Address - Fax:301-475-6507
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029621-1225100000X
MD223812251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22381OtherPT LICENSE
NY029621-1OtherPT LICENSE