Provider Demographics
NPI:1376112060
Name:AMADI, NWONUKWURU IBECHENJOR (MD)
Entity type:Individual
Prefix:DR
First Name:NWONUKWURU
Middle Name:IBECHENJOR
Last Name:AMADI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6316 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2539
Mailing Address - Country:US
Mailing Address - Phone:240-643-2214
Mailing Address - Fax:
Practice Address - Street 1:130 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:203-732-1330
Practice Address - Fax:203-732-1332
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT078281207R00000X
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1376112060Medicaid