Provider Demographics
NPI:1083925945
Name:UGA, AGHAEGBULAM HARACHI (MD)
Entity Type:Individual
Prefix:
First Name:AGHAEGBULAM
Middle Name:HARACHI
Last Name:UGA
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 1:1500 FINSTERWALD PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6011
Mailing Address - Country:US
Mailing Address - Phone:817-209-4946
Mailing Address - Fax:915-201-0950
Practice Address - Street 1:1900 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3309
Practice Address - Country:US
Practice Address - Phone:217-545-0193
Practice Address - Fax:217-545-4735
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4867207R00000X, 2084P0800X
IL125.058546207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine