Provider Demographics
NPI:1770556847
Name:IRO-NWOKEUKWU, OBIOMA (MD)
Entity type:Individual
Prefix:
First Name:OBIOMA
Middle Name:
Last Name:IRO-NWOKEUKWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 CHEW AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2002
Mailing Address - Country:US
Mailing Address - Phone:215-848-1166
Mailing Address - Fax:215-842-0224
Practice Address - Street 1:6613 CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2002
Practice Address - Country:US
Practice Address - Phone:215-848-1166
Practice Address - Fax:215-842-0224
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063864L207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017587000011Medicaid
G94115Medicare UPIN
PA027452Medicare PIN