Provider Demographics
NPI:1619289386
Name:NWOGA, OBIANUJU GERALDINE (MD)
Entity Type:Individual
Prefix:MRS
First Name:OBIANUJU
Middle Name:GERALDINE
Last Name:NWOGA
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 1:14113 ROBERT PARIS CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-956-6757
Mailing Address - Fax:855-359-2261
Practice Address - Street 1:14113 ROBERT PARIS CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-956-6757
Practice Address - Fax:855-359-2261
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2023-08-31
Deactivation Date:2023-05-23
Deactivation Code:
Reactivation Date:2023-06-09
Provider Licenses
StateLicense IDTaxonomies
IL125.057422208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics