Provider Demographics
NPI:1760465421
Name:CHIMEKA ANYANWOKE, GERTRUDE I O (MD)
Entity Type:Individual
Prefix:DR
First Name:GERTRUDE
Middle Name:I O
Last Name:CHIMEKA ANYANWOKE
Suffix:
Gender:F
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:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70821-0583
Mailing Address - Country:US
Mailing Address - Phone:225-289-6803
Mailing Address - Fax:225-289-6483
Practice Address - Street 1:3844 CONVENTION ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3803
Practice Address - Country:US
Practice Address - Phone:225-289-6803
Practice Address - Fax:225-289-6483
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355089Medicaid