Provider Demographics
NPI:1740235076
Name:OLISEMEKA, CHINEDUM IKEMEFUNA (DO)
Entity type:Individual
Prefix:DR
First Name:CHINEDUM
Middle Name:IKEMEFUNA
Last Name:OLISEMEKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 SHADY GROVE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3235
Mailing Address - Country:US
Mailing Address - Phone:301-519-0902
Mailing Address - Fax:
Practice Address - Street 1:15215 SHADY GROVE RD
Practice Address - Street 2:STE. 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3235
Practice Address - Country:US
Practice Address - Phone:301-519-0902
Practice Address - Fax:301-519-0905
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7508207P00000X
VA0102202305207P00000X
MDH67639207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162906516Medicaid
TX162906513Medicaid
TX0048PJOtherBCBS
TX8C0847OtherBCBS
TX162906518Medicaid
TX8J7014OtherBCBS
TX162906513Medicaid
TX8J7014OtherBCBS
TX0048PJOtherBCBS
TX612828Medicare PIN
TX8D6291Medicare PIN