NPIMap

Organization Active NPI

Nwachukwu Medical Associates, PA

  • Internal Medicine Physician
  • Glen Burnie, MD
National Provider Identifier
1154624914
Registry record updated Dec 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D0066985 Issued in MD
Legal business name
NWACHUKWU MEDICAL ASSOCIATES, PA
Practice address
1411 Madison Park Dr
Suite 1B
Glen Burnie, MD 21061-6185
Phone
(410) 553-6360
Fax
(410) 553-6661
NPI assigned
Dec 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ikenna Nwachukwu, M.D.
Title
President
Phone
(301) 367-0918

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X D0066985 MD Primary

Addresses

Primary practice location

1411 Madison Park Dr
Suite 1B
Glen Burnie, MD 21061-6185

Mailing address

1411 Madison Park Dr
Suite 1B
Glen Burnie, MD 21061-6185
Phone (410) 553-6360

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292371200000",
    "number": "1154624914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 MADISON PARK DR",
            "address_2": "SUITE 1B",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616185",
            "telephone_number": "410-553-6360",
            "fax_number": "410-553-6661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 MADISON PARK DR",
            "address_2": "SUITE 1B",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210616185",
            "telephone_number": "410-553-6360",
            "fax_number": "410-553-6661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NWACHUKWU MEDICAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2010-12-15",
        "status": "A",
        "authorized_official_last_name": "NWACHUKWU",
        "authorized_official_first_name": "IKENNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-367-0918",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0066985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.