Provider Demographics
NPI:1538165238
Name:NWACHUKU, VICTOR A (MD PC)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:NWACHUKU
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-388-1561
Mailing Address - Fax:575-388-9952
Practice Address - Street 1:1618 E PINE ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-388-1561
Practice Address - Fax:575-388-9952
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000254207V00000X, 207V00000X
NMR33612176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850480646OtherTAX ID #
NMB5081Medicaid
NM850480646OtherTAX ID #
NM800521023Medicare PIN