Provider Demographics
NPI:1033175401
Name:EMOKPAE, COURAGE OSIFO (MD)
Entity Type:Individual
Prefix:
First Name:COURAGE
Middle Name:OSIFO
Last Name:EMOKPAE
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 1:576 SHELLCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-7710
Mailing Address - Country:US
Mailing Address - Phone:201-407-0140
Mailing Address - Fax:
Practice Address - Street 1:576 SHELLCASTLE RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-7710
Practice Address - Country:US
Practice Address - Phone:201-407-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45533207Q00000X
NC2010-01300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-13570OtherMEDICA
224M6EMOtherBCBS
MN362165100Medicaid
H85018Medicare UPIN
080012443Medicare ID - Type Unspecified