Provider Demographics
NPI:1760786271
Name:OGBONNA, PATRICK IFEANYI OBIORA
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:IFEANYI OBIORA
Last Name:OGBONNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SAINT ALBANS DR STE G
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6286
Mailing Address - Country:US
Mailing Address - Phone:919-876-4949
Mailing Address - Fax:
Practice Address - Street 1:1801 SAINT ALBANS DR STE G
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6286
Practice Address - Country:US
Practice Address - Phone:919-876-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist