Provider Demographics
NPI:1932310778
Name:NWOSU, CALEB CHINEDU (DO)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:CHINEDU
Last Name:NWOSU
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 1:830 5TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4224
Mailing Address - Country:US
Mailing Address - Phone:717-709-7979
Mailing Address - Fax:717-709-7980
Practice Address - Street 1:830 5TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4224
Practice Address - Country:US
Practice Address - Phone:717-709-7979
Practice Address - Fax:717-709-7980
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009983-L208D00000X
PAOS009983L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA012685Medicare PIN
G75531Medicare UPIN