Provider Demographics
NPI:1245613751
Name:OGBECHIE-GODEC, OLUWATOBI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUWATOBI
Middle Name:
Last Name:OGBECHIE-GODEC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUWATOBI
Other - Middle Name:AVELE
Other - Last Name:OGBECHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:92 MONTVALE AVE STE 3000
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3658
Mailing Address - Country:US
Mailing Address - Phone:781-438-6350
Mailing Address - Fax:781-481-0289
Practice Address - Street 1:92 MONTVALE AVE STE 3000
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-438-6350
Practice Address - Fax:781-481-0289
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA280922207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology