Provider Demographics
NPI:1205272754
Name:IFEANYI-NWANZE, IJEOMA G (MD)
Entity type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:G
Last Name:IFEANYI-NWANZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:G
Other - Last Name:NWACHUKWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:STE 225
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6727
Mailing Address - Country:US
Mailing Address - Phone:215-893-7246
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 225
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6727
Practice Address - Country:US
Practice Address - Phone:301-665-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT203944207L00000X
MDD85193207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty