Provider Demographics
NPI:1326153131
Name:DENNAR, CHUKWUNOMNSO NWAKA'IBEYA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUKWUNOMNSO
Middle Name:NWAKA'IBEYA
Last Name:DENNAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 HOLIDAY DR
Mailing Address - Street 2:SUITES 3 - 7
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8287
Mailing Address - Country:US
Mailing Address - Phone:504-361-4203
Mailing Address - Fax:
Practice Address - Street 1:3570 HOLIDAY DR
Practice Address - Street 2:SUITES 3 - 7
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8287
Practice Address - Country:US
Practice Address - Phone:504-361-4203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD201921207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1040401Medicaid
PA1014405060001Medicaid
PAI46334Medicare UPIN
PA1014405060001Medicaid