Provider Demographics
NPI:1760884456
Name:ODOH, CHUKWUDI CHIGBOMKPA
Entity Type:Individual
Prefix:MR
First Name:CHUKWUDI
Middle Name:CHIGBOMKPA
Last Name:ODOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 OGLETHORPE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2735
Mailing Address - Country:US
Mailing Address - Phone:240-423-7782
Mailing Address - Fax:
Practice Address - Street 1:702 OGLETHORPE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2735
Practice Address - Country:US
Practice Address - Phone:240-423-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA6175374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide