Provider Demographics
NPI:1356602429
Name:CHUKWUMA, IFEANYICHUKWU GABRIEL (MD)
Entity type:Individual
Prefix:
First Name:IFEANYICHUKWU
Middle Name:GABRIEL
Last Name:CHUKWUMA
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 1:1060 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-2323
Mailing Address - Fax:757-395-6280
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-2323
Practice Address - Fax:757-395-6280
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-9360207Q00000X
VA0101258135207Q00000X, 208M00000X
MN76960208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356602429Medicaid
VAVVH389BMedicare PIN