Healthcare Provider Details

I. General information

NPI: 1588058549
Provider Name (Legal Business Name): EMMANUEL OBINNA AGUH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GRAND AVE
DAYTON OH
45405-7538
US

IV. Provider business mailing address

9849 KENWORTHY ST
EL PASO TX
79924-4402
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-3276
  • Fax:
Mailing address:
  • Phone: 915-757-2581
  • Fax: 915-757-0720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.144181
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101263750
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: