Provider Demographics
NPI:1255646220
Name:AGADA, NOAH OJONUGWA (MD, MPH, FAAAI)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:OJONUGWA
Last Name:AGADA
Suffix:
Gender:M
Credentials:MD, MPH, FAAAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12750 HORSEFERRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7265
Mailing Address - Country:US
Mailing Address - Phone:317-795-0707
Mailing Address - Fax:317-795-0706
Practice Address - Street 1:12750 HORSEFERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7265
Practice Address - Country:US
Practice Address - Phone:317-795-0707
Practice Address - Fax:317-795-0706
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010757802080P0201X
IN01075780A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201397640Medicaid
IN145590146Medicare PIN