Provider Demographics
NPI:1386955037
Name:ABANULO, CHIDIMMA UCHE (MD)
Entity type:Individual
Prefix:
First Name:CHIDIMMA
Middle Name:UCHE
Last Name:ABANULO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIDIMMA
Other - Middle Name:UCHE
Other - Last Name:ETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14852 NW DEERFOOT LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1552
Mailing Address - Country:US
Mailing Address - Phone:404-394-0493
Mailing Address - Fax:
Practice Address - Street 1:5289 NE ELAM YOUNG PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7551
Practice Address - Country:US
Practice Address - Phone:971-353-4925
Practice Address - Fax:971-353-4926
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD187711207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500752674Medicaid