Provider Demographics
NPI:1588866479
Name:EZEALAH, EZINMA (MD)
Entity type:Individual
Prefix:DR
First Name:EZINMA
Middle Name:
Last Name:EZEALAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EZINMA
Other - Middle Name:
Other - Last Name:ACHEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2104A WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5941
Mailing Address - Country:US
Mailing Address - Phone:864-336-2323
Mailing Address - Fax:864-236-4222
Practice Address - Street 1:2104A WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5941
Practice Address - Country:US
Practice Address - Phone:864-336-2323
Practice Address - Fax:864-236-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD37517207KA0200X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC45168157OtherMEDICARE PTAN