Healthcare Provider Details

I. General information

NPI: 1427073675
Provider Name (Legal Business Name): OBIORA MATTHIAS OGBUAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 RHODE ISLAND AVENUE NE
WASHINGTON DC DC
20018
US

IV. Provider business mailing address

PO BOX 41035
WASHINGTON DC DC
20018
US

V. Phone/Fax

Practice location:
  • Phone: 202-636-3781
  • Fax: 202-832-0575
Mailing address:
  • Phone: 202-636-3781
  • Fax: 202-832-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number8711
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: