Provider Demographics
NPI:1346209707
Name:OGBATA, SYLVESTER IZUCHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVESTER
Middle Name:IZUCHUKWU
Last Name:OGBATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7619 BERRYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-9817
Mailing Address - Country:US
Mailing Address - Phone:203-545-9119
Mailing Address - Fax:704-940-5589
Practice Address - Street 1:1400 MEDFORD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5624
Practice Address - Country:US
Practice Address - Phone:704-940-5588
Practice Address - Fax:704-940-5589
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401554207R00000X, 207RH0002X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900398Medicaid
SCN01554Medicaid
SCN01554Medicaid