Provider Demographics
NPI:1669497442
Name:CHIGBUE, BRIAN ADIMOLISA (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ADIMOLISA
Last Name:CHIGBUE
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 1:7943 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743
Mailing Address - Country:US
Mailing Address - Phone:301-324-0724
Mailing Address - Fax:301-324-0725
Practice Address - Street 1:7943 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743
Practice Address - Country:US
Practice Address - Phone:301-324-0724
Practice Address - Fax:301-324-0725
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18085Medicare UPIN
MD00B006R84Medicare ID - Type Unspecified