Provider Demographics
NPI:1184069965
Name:ANIDI, IFEANYICHUKWU UGOCHUKWU (MD PHD)
Entity type:Individual
Prefix:
First Name:IFEANYICHUKWU
Middle Name:UGOCHUKWU
Last Name:ANIDI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTER DRIVE
Mailing Address - Street 2:ROOM 2C145
Mailing Address - City:BETHESDA
Mailing Address - State:DC
Mailing Address - Zip Code:20892-1662
Mailing Address - Country:US
Mailing Address - Phone:301-496-9320
Mailing Address - Fax:301-402-1213
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:100 CENTREX
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4238
Practice Address - Country:US
Practice Address - Phone:215-662-2200
Practice Address - Fax:215-662-7919
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD460074207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine