Provider Demographics
NPI:1710207519
Name:IGWE, CHINEDU ANGELA EBERE (MD)
Entity Type:Individual
Prefix:
First Name:CHINEDU
Middle Name:ANGELA EBERE
Last Name:IGWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHINEDU
Other - Middle Name:EBERE
Other - Last Name:NKWOGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:95 ARCH ST
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-375-7436
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-375-7436
Practice Address - Fax:860-679-4474
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT051818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1710207519Medicaid