Provider Demographics
NPI:1871584656
Name:OSUJI, CHUMA G (DO)
Entity type:Individual
Prefix:DR
First Name:CHUMA
Middle Name:G
Last Name:OSUJI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:CHUMA
Other - Middle Name:G
Other - Last Name:OSUJI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2752 CARLETON CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1356
Mailing Address - Country:US
Mailing Address - Phone:813-732-5505
Mailing Address - Fax:813-878-2224
Practice Address - Street 1:6351 W LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2676
Practice Address - Country:US
Practice Address - Phone:814-838-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8399207Q00000X
PAOS010091L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272103100Medicaid
FLE7203YMedicare ID - Type Unspecified