Provider Demographics
NPI:1922021914
Name:NWANODI, OROMA BEATRICE AFIONG (MD)
Entity type:Individual
Prefix:MS
First Name:OROMA
Middle Name:BEATRICE AFIONG
Last Name:NWANODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OROMA
Other - Middle Name:BEATRICE
Other - Last Name:NWANODI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:70260 MOTTLE CIR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2421
Mailing Address - Country:US
Mailing Address - Phone:314-304-2946
Mailing Address - Fax:
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-744-1478
Practice Address - Fax:315-448-3548
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006017607207V00000X
WY7239A207V00000X
CAC55184207V00000X
NY2350311207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA122181OtherMEDICARE PTAN
MO121695300Medicaid
138262Medicare UPIN
MO121695300Medicaid