Provider Demographics
NPI:1023267465
Name:EZEADICHIE, CHIOMA A (DO)
Entity type:Individual
Prefix:DR
First Name:CHIOMA
Middle Name:A
Last Name:EZEADICHIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7776
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-7776
Mailing Address - Country:US
Mailing Address - Phone:888-985-2727
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:2 8TH ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-3347
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB089770002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine