Provider Demographics
NPI:1366677791
Name:OSEMOBOR, EHIKIOYA OSAMUDIAMEN (MD)
Entity type:Individual
Prefix:DR
First Name:EHIKIOYA
Middle Name:OSAMUDIAMEN
Last Name:OSEMOBOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:28 TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084-6069
Mailing Address - Country:US
Mailing Address - Phone:540-616-8991
Mailing Address - Fax:
Practice Address - Street 1:2460 LEE HIGHWAY
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301
Practice Address - Country:US
Practice Address - Phone:540-980-8804
Practice Address - Fax:540-980-8161
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101245516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine