Provider Demographics
NPI:1598788770
Name:ANYOHA, ANSELM CHIBUIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANSELM
Middle Name:CHIBUIKE
Last Name:ANYOHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3715 MAIN ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3618
Mailing Address - Country:US
Mailing Address - Phone:203-371-4800
Mailing Address - Fax:203-371-4900
Practice Address - Street 1:3715 MAIN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3618
Practice Address - Country:US
Practice Address - Phone:203-371-4800
Practice Address - Fax:203-371-4900
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0352792080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001352799Medicaid
CT370001266Medicare ID - Type Unspecified
CT001352799Medicaid