Provider Demographics
NPI:1184697070
Name:OGBONNA, MARTINA C (MD)
Entity type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:C
Last Name:OGBONNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARTINA
Other - Middle Name:C
Other - Last Name:EKECHUKWU-OGBONNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-0006
Mailing Address - Fax:713-790-2727
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-0006
Practice Address - Fax:713-790-2727
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9927207Q00000X, 207R00000X, 208M00000X
CT043670207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001436709Medicaid
TX288807503Medicaid
TX8EE938OtherBLUE CROSS BLUE SHIELD
CT001436709Medicaid
TX8EE938OtherBLUE CROSS BLUE SHIELD
TX288807503Medicaid