Provider Demographics
NPI:1902984909
Name:OBIANWU, CHIKE W (MD,MBA,FACOG,FACS)
Entity Type:Individual
Prefix:DR
First Name:CHIKE
Middle Name:W
Last Name:OBIANWU
Suffix:
Gender:M
Credentials:MD,MBA,FACOG,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FOXHILL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088
Mailing Address - Country:US
Mailing Address - Phone:609-268-7243
Mailing Address - Fax:856-764-5723
Practice Address - Street 1:5045 ROUTE 130
Practice Address - Street 2:SUITE I
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9707
Practice Address - Country:US
Practice Address - Phone:856-764-7660
Practice Address - Fax:856-764-5723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05844600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5335507Medicaid
E15546Medicare UPIN
NJ5335507Medicaid