Provider Demographics
NPI:1871166033
Name:LADY VIRGINIA LLC
Entity type:Organization
Organization Name:LADY VIRGINIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIEMEZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYEWUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-475-7647
Mailing Address - Street 1:2601 TULANE AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7462
Mailing Address - Country:US
Mailing Address - Phone:504-874-1181
Mailing Address - Fax:
Practice Address - Street 1:2601 TULANE AVE STE 615
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7462
Practice Address - Country:US
Practice Address - Phone:504-874-1181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty