Provider Demographics
NPI:1366642399
Name:UCHECHI T OPAIGBEOGU MD
Entity Type:Organization
Organization Name:UCHECHI T OPAIGBEOGU MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:UCHECHI
Authorized Official - Middle Name:T
Authorized Official - Last Name:OPAIGBEOGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-686-0067
Mailing Address - Street 1:6188 OXON HILL RD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3113
Mailing Address - Country:US
Mailing Address - Phone:301-686-0067
Mailing Address - Fax:301-686-0479
Practice Address - Street 1:6188 OXON HILL RD
Practice Address - Street 2:SUITE 701
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3113
Practice Address - Country:US
Practice Address - Phone:301-686-0067
Practice Address - Fax:301-686-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011060700Medicaid
MD081441500Medicaid
080039267OtherRAIL ROAD MEDICARE
MD8061UTOtherCAREFIRST BLUECROSS BLUES
MD081441500Medicaid
492206Medicare PIN