Provider Demographics
NPI:1063702553
Name:AGUH, CRYSTAL UGOCHI (MD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:UGOCHI
Last Name:AGUH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UGOCHI
Other - Middle Name:CRYSTAL
Other - Last Name:AGI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1550 ORLEANS ST
Mailing Address - Street 2:CRB II ROOM 211
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0014
Mailing Address - Country:US
Mailing Address - Phone:410-955-2400
Mailing Address - Fax:410-955-8645
Practice Address - Street 1:1550 ORLEANS ST
Practice Address - Street 2:CRB II ROOM 211
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0014
Practice Address - Country:US
Practice Address - Phone:410-955-2400
Practice Address - Fax:410-955-8645
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD80005207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology