Provider Demographics
NPI:1538546494
Name:OMEOGU, CHINYERE NKEMDIRIM (MD)
Entity type:Individual
Prefix:DR
First Name:CHINYERE
Middle Name:NKEMDIRIM
Last Name:OMEOGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CITY AVE UNIT ED1029
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3917
Mailing Address - Country:US
Mailing Address - Phone:678-777-5584
Mailing Address - Fax:
Practice Address - Street 1:1001 CITY AVE UNIT ED1029
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3917
Practice Address - Country:US
Practice Address - Phone:678-777-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4564492083P0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program