Provider Demographics
NPI:1457355380
Name:CHIONUMA, HENRY N (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:N
Last Name:CHIONUMA
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 1:7711 OSWEGO ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2322
Mailing Address - Country:US
Mailing Address - Phone:315-652-1034
Mailing Address - Fax:315-652-1493
Practice Address - Street 1:7711 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-2322
Practice Address - Country:US
Practice Address - Phone:315-652-1034
Practice Address - Fax:315-652-1493
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY165909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00976292Medicaid
NY52039BMedicare PIN
NY110033863Medicare PIN
NY00976292Medicaid
NYRB6708Medicare PIN