Provider Demographics
NPI:1023225604
Name:ASTOJI, EDDY OSHOMAH
Entity type:Individual
Prefix:
First Name:EDDY
Middle Name:OSHOMAH
Last Name:ASTOJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CIRCLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1993
Mailing Address - Country:US
Mailing Address - Phone:907-382-1689
Mailing Address - Fax:907-222-2659
Practice Address - Street 1:1800 CIRCLEWOOD DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-1993
Practice Address - Country:US
Practice Address - Phone:907-382-1689
Practice Address - Fax:907-222-2659
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK902247171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM2374Medicaid