Provider Demographics
NPI:1801214937
Name:MBADUGHA, OSITADINMA LORENZO (MD)
Entity Type:Individual
Prefix:DR
First Name:OSITADINMA
Middle Name:LORENZO
Last Name:MBADUGHA
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 1:1500 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5332
Mailing Address - Country:US
Mailing Address - Phone:804-371-1675
Mailing Address - Fax:804-225-1764
Practice Address - Street 1:1500 N 28TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5332
Practice Address - Country:US
Practice Address - Phone:804-371-1675
Practice Address - Fax:804-225-1764
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012647162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry