Provider Demographics
NPI:1316053465
Name:ERONDU, AMAECHI I (MD)
Entity type:Individual
Prefix:
First Name:AMAECHI
Middle Name:I
Last Name:ERONDU
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:PO BOX 784305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4305
Mailing Address - Country:US
Mailing Address - Phone:844-565-6473
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-574-6851
Practice Address - Fax:202-279-7370
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083834207L00000X
DCMD042615207L00000X
FLME89641207L00000X
MDD0076752207L00000X
PAMD436042207L00000X
VA0101248339207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2468628Medicaid
OHP00112461OtherRAILROAD MEDICARE
OH000000324391OtherANTHEM
OH4133841Medicare PIN
OH2468628Medicaid