Provider Demographics
NPI:1427073675
Name:OGBUAWA, OBIORA MATTHIAS (MD)
Entity type:Individual
Prefix:
First Name:OBIORA
Middle Name:MATTHIAS
Last Name:OGBUAWA
Suffix:
Gender:M
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:PO BOX 41035
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20018
Mailing Address - Country:US
Mailing Address - Phone:202-636-3781
Mailing Address - Fax:202-832-0575
Practice Address - Street 1:1615 RHODE ISLAND AVENUE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-636-3781
Practice Address - Fax:202-832-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC8711207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010795100Medicaid
B94018Medicare UPIN
DC010795100Medicaid