Provider Demographics
NPI:1720569171
Name:IGBOANUGO, ADAOBI E
Entity Type:Individual
Prefix:
First Name:ADAOBI
Middle Name:E
Last Name:IGBOANUGO
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 1:1108 N MOUNT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2216
Mailing Address - Country:US
Mailing Address - Phone:312-978-7878
Mailing Address - Fax:
Practice Address - Street 1:700 W 40TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2140
Practice Address - Country:US
Practice Address - Phone:410-235-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD258462251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD25846OtherSTATE PT LICENSE