Provider Demographics
NPI:1265494686
Name:AGOR, LONGINUS OLEWUIKE
Entity Type:Individual
Prefix:
First Name:LONGINUS
Middle Name:OLEWUIKE
Last Name:AGOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1370 W D ST
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26895208M00000X
NC200300922208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC268953Medicaid
D2395OtherMEDCOST
SC268953Medicaid
7066553OtherAETNA
804192OtherPARTNERS/PARTNERS MEDICAR
2387772OtherUNITED HEALTH CARE
NC89136G1Medicaid
2120868OtherMAMSI
NC2023496Medicare ID - Type Unspecified
NC89136G1Medicaid
D2395OtherMEDCOST
804192OtherPARTNERS/PARTNERS MEDICAR
SCAA30125019Medicare PIN
2120868OtherMAMSI
NC2023496BMedicare PIN
SCI115158065Medicare PIN