Provider Demographics
NPI:1447295159
Name:OKWARA, ADANMA MBADINUJU (MD)
Entity type:Individual
Prefix:
First Name:ADANMA
Middle Name:MBADINUJU
Last Name:OKWARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADANMA
Other - Middle Name:IJEOMA
Other - Last Name:MBADINUJU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:404 S SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5060
Mailing Address - Country:US
Mailing Address - Phone:704-291-9267
Mailing Address - Fax:704-283-7939
Practice Address - Street 1:404 S SUTHERLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5060
Practice Address - Country:US
Practice Address - Phone:704-291-9267
Practice Address - Fax:704-776-4078
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902920Medicaid
NC165FVOtherBCBS NC
SC283874Medicaid
NCNC2975AMedicare PIN
NC165FVOtherBCBS NC
SCAA1282A269Medicare PIN