Provider Demographics
NPI:1356634109
Name:EGBUJI, ADA (MD, MSPH, FACOEM)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:EGBUJI
Suffix:
Gender:F
Credentials:MD, MSPH, FACOEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 1021
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86TH MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:RAMSTEIN
Practice Address - State:AB
Practice Address - Zip Code:09094
Practice Address - Country:DE
Practice Address - Phone:637-146-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17340208800000X, 2083X0100X
NY3014922083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208800000XAllopathic & Osteopathic PhysiciansUrology
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine