Provider Demographics
NPI: | 1497045496 |
---|---|
Name: | ONYEASO, NDUCHE CHIKA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | NDUCHE |
Middle Name: | CHIKA |
Last Name: | ONYEASO |
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: | 1638 OWEN DR |
Mailing Address - Street 2: | ATTN: MANAGED CARE PLANNING |
Mailing Address - City: | FAYETTEVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28304-3424 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-615-6949 |
Mailing Address - Fax: | 910-615-9761 |
Practice Address - Street 1: | 101 ROBESON ST |
Practice Address - Street 2: | SUITE 405 |
Practice Address - City: | FAYETTEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28301-5552 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-615-1623 |
Practice Address - Fax: | 910-321-6248 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-04-11 |
Last Update Date: | 2014-11-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 2013-01479 | 207R00000X, 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | NCI801A | Medicare PIN |