Provider Demographics
NPI:1124091582
Name:EFOBI, NGOZI JULIET (MD)
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:JULIET
Last Name:EFOBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLANCHARD LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-5843
Mailing Address - Country:US
Mailing Address - Phone:304-267-4506
Mailing Address - Fax:
Practice Address - Street 1:1150 PROFESSIONAL CT
Practice Address - Street 2:SUITE B
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5852
Practice Address - Country:US
Practice Address - Phone:301-797-4901
Practice Address - Fax:301-797-4464
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00636742081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46978Medicare UPIN
MD415L-N016Medicare ID - Type Unspecified