Provider Demographics
NPI:1114383692
Name:AGBELI, MARTHA OFEIBEA (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:OFEIBEA
Last Name:AGBELI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 S CHURCH ST APT S101
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6582
Mailing Address - Country:US
Mailing Address - Phone:401-663-4100
Mailing Address - Fax:
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER (DPT OF PSYCHIATRY)
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2167
Practice Address - Fax:413-447-2176
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2305889363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health