Provider Demographics
NPI:1467577650
Name:IKE NNAWUCHI, MD, PC
Entity Type:Organization
Organization Name:IKE NNAWUCHI, MD, PC
Other - Org Name:CHEVY CHASE PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:IKECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAWUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-679-0620
Mailing Address - Street 1:5335 WISCONSIN AVE NW
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2030
Mailing Address - Country:US
Mailing Address - Phone:202-679-0620
Mailing Address - Fax:
Practice Address - Street 1:5335 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 450
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2030
Practice Address - Country:US
Practice Address - Phone:202-679-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0350682084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02488Medicare PIN