Provider Demographics
NPI:1346552692
Name:OGBATA, OBIAGELI UCHENNA (MD)
Entity Type:Individual
Prefix:
First Name:OBIAGELI
Middle Name:UCHENNA
Last Name:OGBATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OBIAGELI
Other - Middle Name:UCHENNA
Other - Last Name:OJUKWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-4485
Mailing Address - Fax:704-316-4490
Practice Address - Street 1:125 QUEENS RD STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3215
Practice Address - Country:US
Practice Address - Phone:980-302-6400
Practice Address - Fax:980-302-6405
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201001465207R00000X, 207RH0003X
NC2010-01465207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1257Medicaid
NC1346552692Medicaid
NCNCJ483AMedicare PIN