Provider Demographics
NPI:1902052848
Name:AGUWA, ADANZE (MD)
Entity type:Individual
Prefix:
First Name:ADANZE
Middle Name:
Last Name:AGUWA
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 1:16 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1905
Mailing Address - Country:US
Mailing Address - Phone:862-250-1352
Mailing Address - Fax:
Practice Address - Street 1:1 HALLECK ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-7085
Practice Address - Country:US
Practice Address - Phone:347-774-7359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1377739207R00000X
MIL1377740207R00000X
VA0116021876390200000X
NY274508-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program