Provider Demographics
NPI:1376310185
Name:OFOEGBU, IFEANYI
Entity Type:Individual
Prefix:MR
First Name:IFEANYI
Middle Name:
Last Name:OFOEGBU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 FAIRVIEW AVE APT 419
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5959
Mailing Address - Country:US
Mailing Address - Phone:240-229-7235
Mailing Address - Fax:
Practice Address - Street 1:790 FAIRVIEW AVE APT 419
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5959
Practice Address - Country:US
Practice Address - Phone:240-229-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant