Provider Demographics
NPI:1275791451
Name:MOKONOGHO, JOSEPHINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:MOKONOGHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W 14TH ST
Mailing Address - Street 2:STE 1E40
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1013
Mailing Address - Country:US
Mailing Address - Phone:302-320-2100
Mailing Address - Fax:302-320-2121
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-25
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00135642084P0800X, 2084P0015X
PAMD 4426192084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275791451OtherPARTNERS
NC1275791451OtherTRICARE
NC1275791451OtherUBH
NC1275791451Medicaid
NC1275791541OtherSANDHILLS
NCQ0005MOtherSC MEDICAID
NC1275791451OtherCENTERPOINT
NC1275791451OtherCAROLINA BEHAVIORAL HEALTH AL
NC277901OtherMEDCOST
NC9695720OtherAETNA
NC3385556OtherUNITED HEALTHCARE
NC185TROtherBCBS
NC1275791451Medicaid