Provider Demographics
NPI:1568511525
Name:EMODI, OGO
Entity Type:Individual
Prefix:MRS
First Name:OGO
Middle Name:
Last Name:EMODI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 PICKETT RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6000
Mailing Address - Country:US
Mailing Address - Phone:919-493-6871
Mailing Address - Fax:919-493-6878
Practice Address - Street 1:3020 PICKETT RD
Practice Address - Street 2:SUITE 141
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6000
Practice Address - Country:US
Practice Address - Phone:919-493-6871
Practice Address - Fax:919-493-6878
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409340Medicaid
NC7804763Medicaid
NC8300547Medicaid