Provider Demographics
NPI:1023070547
Name:OGU, DONATUS (MD)
Entity type:Individual
Prefix:
First Name:DONATUS
Middle Name:
Last Name:OGU
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:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-0578
Mailing Address - Country:US
Mailing Address - Phone:704-923-0446
Mailing Address - Fax:704-923-8319
Practice Address - Street 1:107 N SUMMEY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1824
Practice Address - Country:US
Practice Address - Phone:704-923-0446
Practice Address - Fax:704-923-8319
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
76743OtherMEDCOST
110159213OtherRAILROAD MEDICARE
NC8910826Medicaid
116085OtherAETNA
21564OtherPARTNERS/PARTNERS MEDICAR
441733OtherUNITED HEALTH CARE
1184723OtherCIGNA
253704OtherMAMSI
10826OtherBCBS
N0055COtherSOUTH CAROLINA MEDICAID
NC2190909EMedicare ID - Type Unspecified
1184723OtherCIGNA