Provider Demographics
NPI:1992012579
Name:SOFOWORA, GBEMIGA (MD)
Entity Type:Individual
Prefix:
First Name:GBEMIGA
Middle Name:
Last Name:SOFOWORA
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4967
Mailing Address - Fax:614-293-5614
Practice Address - Street 1:6700 UNIVERSITY BLVD FL 5
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3508
Practice Address - Country:US
Practice Address - Phone:614-293-4967
Practice Address - Fax:614-293-5614
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096296207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3100978Medicaid