Provider Demographics
NPI:1093926206
Name:JOSEPH V.I. OSUAGWU, MD, PC
Entity Type:Organization
Organization Name:JOSEPH V.I. OSUAGWU, MD, PC
Other - Org Name:GOODTIME FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-325-5700
Mailing Address - Street 1:5805 MORAVIA RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-6133
Mailing Address - Country:US
Mailing Address - Phone:410-325-5700
Mailing Address - Fax:
Practice Address - Street 1:7131 LIBERTY RD STE 103
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-4580
Practice Address - Country:US
Practice Address - Phone:410-325-5700
Practice Address - Fax:410-325-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD819601000Medicaid