Provider Demographics
NPI:1053364802
Name:EZIDIEGWU, CHRISTIAN N (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:N
Last Name:EZIDIEGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2029
Mailing Address - Country:US
Mailing Address - Phone:315-447-7041
Mailing Address - Fax:
Practice Address - Street 1:100 OSTROM AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2029
Practice Address - Country:US
Practice Address - Phone:315-447-7041
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230913207ZB0001X, 207ZC0500X, 207ZD0900X, 207ZF0201X, 207ZI0100X, 207ZM0300X, 207ZP0007X, 207ZP0102X, 207ZP0213X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Not Answered207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Not Answered207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Not Answered207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
Not Answered207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Not Answered207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology