Doctor Name: | CHINYERE MBAGWU |
NPI Number: | 1619391760 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 0101259717 |
Business Practice Address: | 3551 Roger Brooke Drive Mche/me Jbsa Fort Sam Houston, TX - 78234 |
Business Phone Number: | 2109165545 |
Business Fax Number: | |
Mailing Address: | 10806 Mathom Lndg, Unit 1 UNIVERSAL CITY |
State: | TX |
Postal Code: | 781484699 |
Phone Number: | 5102054106 |
Fax Number: | |
NPI Enumeration Date: | 02/10/2014 |
NPI Last Update Date: | 04/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101259717 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |