Provider Demographics
NPI:1649695701
Name:EZEIGWE, CHINEME UMUNNA (PA)
Entity type:Individual
Prefix:
First Name:CHINEME
Middle Name:UMUNNA
Last Name:EZEIGWE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHINEME
Other - Middle Name:
Other - Last Name:EZEIGWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:8012 PATUXENT LANDING LOOP
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1975
Mailing Address - Country:US
Mailing Address - Phone:240-882-7989
Mailing Address - Fax:
Practice Address - Street 1:8106 STAYTON DR STE D
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9615
Practice Address - Country:US
Practice Address - Phone:301-725-5050
Practice Address - Fax:301-725-5111
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003044363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical