Provider Demographics
NPI:1336273911
Name:NWANESHIUDU, IFEANYI (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:
Last Name:NWANESHIUDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S CAMP MEADE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2766
Mailing Address - Country:US
Mailing Address - Phone:443-410-3325
Mailing Address - Fax:
Practice Address - Street 1:518 S CAMP MEADE RD STE 1
Practice Address - Street 2:
Practice Address - City:LINTHICUM HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:21090-2766
Practice Address - Country:US
Practice Address - Phone:267-241-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC70003460208600000X
MDD00783602083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty