Provider Demographics
NPI:1831181247
Name:OSAROGIAGBON, RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:OSAROGIAGBON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 HUMPHREYS CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2363
Practice Address - Country:US
Practice Address - Phone:901-752-6131
Practice Address - Fax:901-751-6170
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18819207RH0003X
TN39287207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR99703OtherBLUE CROSS BLUE SHIELD
AR155632001Medicaid
MS08106510Medicaid
TN3326804Medicaid
5781084OtherAETNA
4195556OtherCIGNA
TN4099273OtherBLUE CROSS BLUE SHIELD
MS08106510Medicaid
MS830000079Medicare PIN
G20253Medicare UPIN
MS08106510Medicaid
TN3326804Medicare PIN