Provider Demographics
NPI:1588725881
Name:AGHEDO, OSASERE LAMBERT (DO)
Entity type:Individual
Prefix:DR
First Name:OSASERE
Middle Name:LAMBERT
Last Name:AGHEDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 DALLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-5452
Mailing Address - Country:US
Mailing Address - Phone:334-872-4778
Mailing Address - Fax:334-872-8646
Practice Address - Street 1:731 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5452
Practice Address - Country:US
Practice Address - Phone:334-872-4778
Practice Address - Fax:334-872-8646
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-644207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-39993OtherBCBS
ALH06550Medicare UPIN