Provider Demographics
NPI:1710058730
Name:OGUNRO, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:OGUNRO
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 1:145 HOSPITAL AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1462
Mailing Address - Country:US
Mailing Address - Phone:814-375-2070
Mailing Address - Fax:814-375-2076
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-2070
Practice Address - Fax:814-375-2076
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-1182084N0600X
KY495982084N0600X
PAMD036291L2084N0600X
KYTP3182084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00237590Medicaid
KY7100413180Medicaid
PA0010358330005Medicaid
NY00237590Medicaid
PA0010358330005Medicaid