Provider Demographics
NPI:1386328060
Name:NWOGU, CHUKWUDI AMARACHUKWU (MD)
Entity type:Individual
Prefix:
First Name:CHUKWUDI
Middle Name:AMARACHUKWU
Last Name:NWOGU
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 1:3330 CIRCLE BROOK DRIVE, APARTMENT F, ROANOKE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-597-3357
Mailing Address - Fax:540-985-9612
Practice Address - Street 1:3 RIVERSIDE CIRCLE, 2ND FLOOR NEUROLOGY DEPARTMENT
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016
Practice Address - Country:US
Practice Address - Phone:540-224-5170
Practice Address - Fax:540-985-9612
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2024-01-31
Deactivation Date:2024-01-17
Deactivation Code:
Reactivation Date:2024-01-31
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA01160385052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAW281230606OtherAETNA