Provider Demographics
NPI:1407845910
Name:SSENGOBA-UBOGU, ANISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANISA
Middle Name:
Last Name:SSENGOBA-UBOGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 STADIUM TRACE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4528
Mailing Address - Country:US
Mailing Address - Phone:205-588-1748
Mailing Address - Fax:205-558-2554
Practice Address - Street 1:5330 STADIUM TRACE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4528
Practice Address - Country:US
Practice Address - Phone:205-588-1748
Practice Address - Fax:205-558-2554
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32837207Q00000X, 207Q00000X
OH35084137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193241003Medicaid
OH2484600Medicaid
I09790Medicare UPIN
OHSS4129761Medicare PIN
TX8K4262Medicare PIN
TX8K6528Medicare PIN
TX193241003Medicaid
TX8K6530Medicare PIN