Provider Demographics
NPI:1023037165
Name:OGBURN, CHRISTOPHER W (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:OGBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4700 PUDDLEDOCK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1268
Mailing Address - Country:US
Mailing Address - Phone:804-526-1111
Mailing Address - Fax:804-526-2978
Practice Address - Street 1:4700 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1268
Practice Address - Country:US
Practice Address - Phone:804-526-1111
Practice Address - Fax:804-526-2978
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101058042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74108Medicare UPIN
080007352Medicare ID - Type Unspecified