Provider Demographics
NPI:1013919778
Name:NWOKORO, UGOCHUKWU (MD)
Entity type:Individual
Prefix:
First Name:UGOCHUKWU
Middle Name:
Last Name:NWOKORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UGO
Other - Middle Name:
Other - Last Name:NWOKORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1735 BIG HILL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2201
Mailing Address - Country:US
Mailing Address - Phone:937-224-4325
Mailing Address - Fax:937-224-4327
Practice Address - Street 1:1735 BIG HILL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-2201
Practice Address - Country:US
Practice Address - Phone:937-224-4325
Practice Address - Fax:937-224-4327
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078825N207R00000X
OH35078825-N2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2244897Medicaid
OHNW4051323Medicare ID - Type Unspecified
OH2244897Medicaid