Provider Demographics
NPI:1770288318
Name:NWANEKI, CHISOM MARCELLUS (MD)
Entity type:Individual
Prefix:
First Name:CHISOM
Middle Name:MARCELLUS
Last Name:NWANEKI
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 1:110 TERRACE CT APT 5
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7385
Mailing Address - Country:US
Mailing Address - Phone:423-676-0657
Mailing Address - Fax:
Practice Address - Street 1:240 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1723
Practice Address - Country:US
Practice Address - Phone:423-676-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program