Provider Demographics
NPI:1558948778
Name:EZEUDEMBA, OBIORA (MD)
Entity type:Individual
Prefix:
First Name:OBIORA
Middle Name:
Last Name:EZEUDEMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OBIORA
Other - Middle Name:CHIMAOBI
Other - Last Name:EZEUDEMBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4201
Mailing Address - Country:US
Mailing Address - Phone:475-210-5791
Mailing Address - Fax:
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:800-821-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC202401697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine