Provider Demographics
NPI:1275707309
Name:ODILI, OGHENERUONA OSEHI (MD)
Entity Type:Individual
Prefix:DR
First Name:OGHENERUONA
Middle Name:OSEHI
Last Name:ODILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OGHENERUONA
Other - Middle Name:O
Other - Last Name:APOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:
Practice Address - Street 1:1 RICHLAND MEDICAL PARK DR STE 420
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6833
Practice Address - Country:US
Practice Address - Phone:803-434-6430
Practice Address - Fax:803-545-5353
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01872208M00000X, 207R00000X, 207RI0200X
SC32524207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1612047OtherGATEWAY
PA102754389Medicaid
NC151G8OtherBCBS OF NC
PA2151790OtherHIGHMARK BLUE SHIELD
PA30133984 - WMGOtherAMERIHEALTH MERCY
NC1275707309Medicaid
PA30136043OtherAMERIHEALTH MERCY - THFP
NCNC3053BOtherMEDICARE
PAP011543OtherGATEWAY