Provider Demographics
NPI:1467086819
Name:IWUALA, NNAMDI CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:NNAMDI
Middle Name:CHARLES
Last Name:IWUALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 OAK LN
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2513
Mailing Address - Country:US
Mailing Address - Phone:434-200-5757
Mailing Address - Fax:434-200-1128
Practice Address - Street 1:1330 OAK LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2513
Practice Address - Country:US
Practice Address - Phone:434-200-5757
Practice Address - Fax:434-200-1128
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101282002207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine