Provider Demographics
NPI:1104487891
Name:NWAZURUOKEH, HENRY O (DO)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:O
Last Name:NWAZURUOKEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 MEMORIAL PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2748
Mailing Address - Country:US
Mailing Address - Phone:908-847-3300
Mailing Address - Fax:908-847-2889
Practice Address - Street 1:2613 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2246
Practice Address - Country:US
Practice Address - Phone:757-738-1600
Practice Address - Fax:757-465-8616
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207106207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program