Provider Demographics
NPI:1235493305
Name:OGBOTOR, ELOHOR
Entity Type:Individual
Prefix:
First Name:ELOHOR
Middle Name:
Last Name:OGBOTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6527 LANDOVER RD
Mailing Address - Street 2:201
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20781
Mailing Address - Country:US
Mailing Address - Phone:240-751-3115
Mailing Address - Fax:
Practice Address - Street 1:6527 LANDOVER RD
Practice Address - Street 2:201
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20781
Practice Address - Country:US
Practice Address - Phone:240-751-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide