Provider Demographics
NPI:1437413820
Name:OSUORJI, CHINENYE ANTHONIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHINENYE
Middle Name:ANTHONIA
Last Name:OSUORJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHINENYE
Other - Middle Name:ANTHONIA
Other - Last Name:OKPARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3085 ECLIPSE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1667
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3085 ECLIPSE RIDGE LN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1667
Practice Address - Country:US
Practice Address - Phone:585-723-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0625207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program