Provider Demographics
NPI:1053792481
Name:NWACHUKU, ENYINNA L (MD)
Entity type:Individual
Prefix:
First Name:ENYINNA
Middle Name:L
Last Name:NWACHUKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ENYINNA
Other - Middle Name:LEVI
Other - Last Name:NWACHUKU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-1159
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:30 HOPE DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2036
Practice Address - Country:US
Practice Address - Phone:717-531-8521
Practice Address - Fax:717-531-5068
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.146353207T00000X
PAMT208531390200000X
PAMD478077207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program