Provider Demographics
NPI:1689684177
Name:OJIEGBE, VITALIS O (MD)
Entity Type:Individual
Prefix:
First Name:VITALIS
Middle Name:O
Last Name:OJIEGBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT RD
Mailing Address - Street 2:SUITE U-3
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2354
Mailing Address - Country:US
Mailing Address - Phone:301-220-3500
Mailing Address - Fax:301-982-0321
Practice Address - Street 1:6201 GREENBELT RD
Practice Address - Street 2:SUITE U-3
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2354
Practice Address - Country:US
Practice Address - Phone:301-220-3500
Practice Address - Fax:301-982-0321
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO65418207R00000X
NC200200430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1362VOtherBCBS
NC891362VMedicaid
NCP00217614OtherRAILROAD MEDICARE
MD891362VMedicaid
NC1362VOtherBCBS
NCP00217614OtherRAILROAD MEDICARE
NCI03324Medicare UPIN
MD2021647AMedicare PIN