Provider Demographics
NPI:1689166720
Name:OGWURIKE, CHINEDU OLUCHI (MD)
Entity Type:Individual
Prefix:
First Name:CHINEDU OLUCHI
Middle Name:
Last Name:OGWURIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUCHI
Other - Middle Name:
Other - Last Name:OGWURIKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:375 ALLENS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5010
Mailing Address - Country:US
Mailing Address - Phone:401-780-2511
Mailing Address - Fax:401-780-2565
Practice Address - Street 1:31 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-3410
Practice Address - Country:US
Practice Address - Phone:401-444-0590
Practice Address - Fax:401-396-2084
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2023-12-28
Deactivation Date:2019-01-25
Deactivation Code:
Reactivation Date:2019-02-22
Provider Licenses
StateLicense IDTaxonomies
RIMD17895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine