Provider Demographics
NPI:1497450365
Name:OBIANOZIE, PROMISE IFEOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PROMISE
Middle Name:IFEOMA
Last Name:OBIANOZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PROMISE
Other - Middle Name:IFEOMA
Other - Last Name:OBIANOZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:109 BRIDGE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1222
Mailing Address - Country:US
Mailing Address - Phone:434-799-4488
Mailing Address - Fax:434-773-6977
Practice Address - Street 1:109 BRIDGE ST STE 201
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1222
Practice Address - Country:US
Practice Address - Phone:434-799-4488
Practice Address - Fax:434-773-6977
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116038090207R00000X
VA000000000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine