Provider Demographics
NPI:1831460294
Name:ADOGU, OBINNA C (CRNA)
Entity Type:Individual
Prefix:MR
First Name:OBINNA
Middle Name:C
Last Name:ADOGU
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 GAMBRILL CIR
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1950
Mailing Address - Country:US
Mailing Address - Phone:443-348-7253
Mailing Address - Fax:
Practice Address - Street 1:5914 GAMBRILL CIR
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-1950
Practice Address - Country:US
Practice Address - Phone:443-348-7253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190616367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered