Provider Demographics
NPI:1013979152
Name:MBADIWE, CHUKWUEMEKA FELIX
Entity Type:Individual
Prefix:DR
First Name:CHUKWUEMEKA
Middle Name:FELIX
Last Name:MBADIWE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:EMEKA
Other - Middle Name:FELIX
Other - Last Name:MBADIWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1405 FRESNO RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-5121
Mailing Address - Country:US
Mailing Address - Phone:302-477-0752
Mailing Address - Fax:302-477-0752
Practice Address - Street 1:1405 FRESNO RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-5121
Practice Address - Country:US
Practice Address - Phone:302-477-0752
Practice Address - Fax:302-477-0752
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038479L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134Medicaid
SCN00379Medicaid
NC89134Medicaid
H31848AMedicare UPIN
NCBS@BS 134F4Medicare ID - Type Unspecified
3164457 AETNAMedicare ID - Type Unspecified
SCN00379Medicaid