Provider Demographics
NPI:1861448581
Name:NNAEMEKAOKOYEH, RITA OBIAGELI (MD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:OBIAGELI
Last Name:NNAEMEKAOKOYEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:OBIAGELI
Other - Last Name:UGBODE(MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2806 RANDLEMAN RD STE M
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5266
Mailing Address - Country:US
Mailing Address - Phone:336-574-8355
Mailing Address - Fax:336-273-9192
Practice Address - Street 1:2806 RANDLEMAN RD STE M
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5266
Practice Address - Country:US
Practice Address - Phone:336-574-8355
Practice Address - Fax:336-273-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501548208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902980Medicaid