Provider Demographics
NPI:1609033042
Name:IGBERASE, OLUWAFEMI CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:OLUWAFEMI
Middle Name:CHARLES
Last Name:IGBERASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:IGBERASE-JOHN
Other - Last Name:AKODA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3013 KASPAR CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5705
Mailing Address - Country:US
Mailing Address - Phone:301-325-0264
Mailing Address - Fax:
Practice Address - Street 1:3013 KASPAR CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5705
Practice Address - Country:US
Practice Address - Phone:301-325-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program