Provider Demographics
NPI:1023835329
Name:OGBEBOR, AGATHA ISI
Entity type:Individual
Prefix:
First Name:AGATHA
Middle Name:ISI
Last Name:OGBEBOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 MARTIN LUTHER KING JR
Mailing Address - Street 2:AVE SE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032
Mailing Address - Country:US
Mailing Address - Phone:202-800-4433
Mailing Address - Fax:
Practice Address - Street 1:3019 MARTIN LUTHER KING JR
Practice Address - Street 2:AVE SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-800-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker