Provider Demographics
NPI:1932738382
Name:ONYEAKA, HENRY KOSOROCHI
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:KOSOROCHI
Last Name:ONYEAKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:KOSOROCHI
Other - Last Name:ONYEAKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12 DUNMORE ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2814
Mailing Address - Country:US
Mailing Address - Phone:857-251-2598
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR STE 120A
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-7460
Practice Address - Fax:803-936-7462
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015114002084P0800X
SC920792084P0800X
390200000X
TN710282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program