Healthcare Provider Details

I. General information

NPI: 1073771804
Provider Name (Legal Business Name): ONYEMA EBERECHUKWU OGBUAGU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

211 POMEROY AVE APT 1121
MERIDEN CT
06450-1784
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-6959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number049514
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: