Provider Demographics
NPI:1851952592
Name:AGABA, PETER O (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:O
Last Name:AGABA
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 1:401 MATTHEW ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1635
Mailing Address - Country:US
Mailing Address - Phone:740-568-5669
Mailing Address - Fax:
Practice Address - Street 1:300 E 8TH ST STE 120
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3379
Practice Address - Country:US
Practice Address - Phone:740-374-4273
Practice Address - Fax:740-376-5098
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.144009207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine