Provider Demographics
NPI:1457504128
Name:OBIORA M. OGBUAWA, MDPC
Entity Type:Organization
Organization Name:OBIORA M. OGBUAWA, MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:OBIORA
Authorized Official - Middle Name:MATHIAS
Authorized Official - Last Name:OGBUAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:202-636-3781
Mailing Address - Street 1:PO BOX 41035
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-0435
Mailing Address - Country:US
Mailing Address - Phone:202-636-3781
Mailing Address - Fax:202-832-0575
Practice Address - Street 1:1615 RHODE ISLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1802
Practice Address - Country:US
Practice Address - Phone:202-636-3781
Practice Address - Fax:202-832-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD8711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010795100Medicaid
172432Medicare PIN
B94018Medicare UPIN