Provider Demographics
NPI:1922053248
Name:NWAUCHE, UGWUALA (MD)
Entity Type:Individual
Prefix:DR
First Name:UGWUALA
Middle Name:
Last Name:NWAUCHE
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 1:6608 E W T HARRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-5128
Mailing Address - Country:US
Mailing Address - Phone:704-900-7761
Mailing Address - Fax:
Practice Address - Street 1:6608 E WT HARRIS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5101
Practice Address - Country:US
Practice Address - Phone:704-900-7761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46482207P00000X, 207R00000X
VA0101223755207P00000X, 207R00000X
NC2004-01105207P00000X, 207R00000X, 208D00000X
FLME140368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906725Medicaid
NC5906725Medicaid