Provider Demographics
NPI:1881708691
Name:AGBEDE, BETTY ORIEJI (MD MPH)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ORIEJI
Last Name:AGBEDE
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-244-7701
Mailing Address - Fax:407-770-0594
Practice Address - Street 1:5554 CLARCONA OCOEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810
Practice Address - Country:US
Practice Address - Phone:407-292-0292
Practice Address - Fax:407-292-5175
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040841E207Q00000X
NC2010-00664207Q00000X
FLME111451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011697570004Medicaid
PA011697570004Medicaid
PAUD444581Medicare ID - Type Unspecified