Provider Demographics
NPI:1588926331
Name:OGBO, CHIAMAKA NNENNA (MD)
Entity type:Individual
Prefix:DR
First Name:CHIAMAKA
Middle Name:NNENNA
Last Name:OGBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIAMAKA
Other - Middle Name:NNENNA
Other - Last Name:MBASO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 ONEIL BLVD
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4250
Mailing Address - Country:US
Mailing Address - Phone:508-342-1101
Mailing Address - Fax:508-342-1924
Practice Address - Street 1:100 ONEIL BLVD
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-4250
Practice Address - Country:US
Practice Address - Phone:508-342-1101
Practice Address - Fax:508-342-1924
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016652207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0126341Medicaid