Provider Demographics
NPI:1487844601
Name:UGWU, OBINNA RAPHAEL (MD)
Entity Type:Individual
Prefix:
First Name:OBINNA
Middle Name:RAPHAEL
Last Name:UGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7555 FOXCHASE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-8686
Mailing Address - Country:US
Mailing Address - Phone:513-275-5833
Mailing Address - Fax:888-316-7547
Practice Address - Street 1:800 COMPTON RD
Practice Address - Street 2:SUITE #21/22
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3826
Practice Address - Country:US
Practice Address - Phone:513-275-8833
Practice Address - Fax:888-316-7547
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086149208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4288221Medicare PIN