Provider Demographics
NPI:1194788042
Name:ERUCHALU, OBINNA NNAEMEKA (MD)
Entity type:Individual
Prefix:
First Name:OBINNA
Middle Name:NNAEMEKA
Last Name:ERUCHALU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 N WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1064
Mailing Address - Country:US
Mailing Address - Phone:704-375-0404
Mailing Address - Fax:704-375-0705
Practice Address - Street 1:485 N WENDOVER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1064
Practice Address - Country:US
Practice Address - Phone:704-375-0404
Practice Address - Fax:704-375-0705
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NC383312085R0204X, 2085U0001X, 2086S0129X
NC00-38331208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8930776Medicaid
NC10039OtherPARTNERS MEDICARE
NC1036LOtherBLUE CROSS/BLUE SHIELD
NC10039OtherPARTNERS MEDICARE
NC2345411Medicare ID - Type Unspecified