Healthcare Provider Details

I. General information

NPI: 1346454659
Provider Name (Legal Business Name): EUGENE OGBONNA ONWUZURIKE ARRT R CT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 BEACON VALLEY DRIVE
RALEIGH NC
27604
US

IV. Provider business mailing address

1513 BEACON VALLEY DRIVE
RALEIGH NC
27604
US

V. Phone/Fax

Practice location:
  • Phone: 919-212-2398
  • Fax: 919-212-2798
Mailing address:
  • Phone: 919-212-2398
  • Fax: 919-212-2798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number323983
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: