Provider Demographics
NPI:1033102348
Name:AGWUNA, NGOZI RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:NGOZI
Middle Name:RUTH
Last Name:AGWUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:N
Other - Last Name:AGWUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5084 DORSEY HALL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7711
Mailing Address - Country:US
Mailing Address - Phone:410-772-9463
Mailing Address - Fax:410-992-3509
Practice Address - Street 1:5084 DORSEY HALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7711
Practice Address - Country:US
Practice Address - Phone:410-772-9463
Practice Address - Fax:410-992-3509
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00447952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD128051100Medicaid
MD522027939OtherFEIN