Provider Demographics
NPI:1164424693
Name:OHAEGBULAM, CHIMA O (MD)
Entity Type:Individual
Prefix:
First Name:CHIMA
Middle Name:O
Last Name:OHAEGBULAM
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 86
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0086
Mailing Address - Country:US
Mailing Address - Phone:781-749-9071
Mailing Address - Fax:781-749-2133
Practice Address - Street 1:125 PARKER HILL AVE
Practice Address - Street 2:CONVERSE 4
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-754-6025
Practice Address - Fax:617-754-6026
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160498207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2106191Medicaid
MA2106191Medicaid
MAA38720Medicare ID - Type Unspecified