Provider Demographics
NPI:1699751230
Name:ENEANYA, DENNIS ILOZULIKE (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:ILOZULIKE
Last Name:ENEANYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8286
Practice Address - Street 1:2100 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19130-1400
Practice Address - Country:US
Practice Address - Phone:215-685-0800
Practice Address - Fax:215-685-0846
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD041821L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001278733Medicaid
PA1119230OtherKEYSTONE MERCY HEALTH
PA711224OtherHIGHMARK BLUE SHIELD
PA0547376000OtherINDEPENDENCE BLUE CROSS
PA1595OtherBRAVO HEALTH
PAP00037860OtherRAILROAD MEDICARE
PAP00037860OtherRAILROAD MEDICARE
PA001278733Medicaid