Healthcare Provider Details

I. General information

NPI: 1487282174
Provider Name (Legal Business Name): REBECCA UGURU UKAEGBU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ISAAC ST
MIDDLEBORO MA
02346-2080
US

IV. Provider business mailing address

1405 SPRING ST NW APT 17A
ATLANTA GA
30309-3189
US

V. Phone/Fax

Practice location:
  • Phone: 617-588-0076
  • Fax:
Mailing address:
  • Phone: 781-308-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1016437
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number100945
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: