Provider Demographics
NPI:1104005941
Name:OGBURU-OGBONNAYA, ELEANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANYA
Middle Name:
Last Name:OGBURU-OGBONNAYA
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:STATE PARK
Mailing Address - State:SC
Mailing Address - Zip Code:29147-0209
Mailing Address - Country:US
Mailing Address - Phone:803-788-0038
Mailing Address - Fax:803-788-0655
Practice Address - Street 1:2601 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1218
Practice Address - Country:US
Practice Address - Phone:803-788-0038
Practice Address - Fax:803-788-0655
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC183232084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT23356Medicaid
SCF43451Medicare UPIN