Basic Information
| Provider Information | |||||||||
| NPI: | 1477737740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NWAFOR | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | OKECHUKWU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 GODWIN BLVD 1ST FL | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344821 | ||||||||
| FaxNumber: | 7579344276 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 GODWIN BLVD 1ST FL | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234348038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579344821 | ||||||||
| FaxNumber: | 7579344276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2007 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101258587 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD433280 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.