Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | MD37517 | SC |
Y | 207RR0500X | Rheumatology | MD37517 | SC |
NPI | 1588866479 |
---|---|
Provider Name | Dr. Ezinma Ezealah |
First Address | Greenville, SC 29615-4831 |
Second Address | Greenville, SC 29615-4831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2007 |
Last Update Date | 21/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SC45168157 | MEDICARE PTAN (01) | SC |