Provider Demographics
NPI:1700845641
Name:OSUAGWU, JOSEPH-VENATIUS I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH-VENATIUS
Middle Name:I
Last Name:OSUAGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4502 HAYWAGON WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6555
Mailing Address - Country:US
Mailing Address - Phone:410-325-5700
Mailing Address - Fax:410-325-5765
Practice Address - Street 1:7131 LIBERTY RD STE 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4580
Practice Address - Country:US
Practice Address - Phone:410-325-5700
Practice Address - Fax:410-325-5700
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050824208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1093926206Medicaid
MD1700845641Medicaid