Provider Demographics
NPI:1831444231
Name:UGOH, LASERIAN NDUBISI
Entity type:Individual
Prefix:
First Name:LASERIAN
Middle Name:NDUBISI
Last Name:UGOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RHONDA CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2038
Mailing Address - Country:US
Mailing Address - Phone:443-851-0013
Mailing Address - Fax:
Practice Address - Street 1:15 RHONDA CT
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2038
Practice Address - Country:US
Practice Address - Phone:443-851-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide