Provider Demographics
NPI:1184928848
Name:HANORA MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:HANORA MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CHIGBO
Authorized Official - Last Name:UDOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-860-0017
Mailing Address - Street 1:PO BOX 88033
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-8033
Mailing Address - Country:US
Mailing Address - Phone:910-860-0017
Mailing Address - Fax:910-860-0015
Practice Address - Street 1:2620 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306
Practice Address - Country:US
Practice Address - Phone:910-860-0017
Practice Address - Fax:910-860-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913279Medicaid
NC2075285Medicare PIN