Healthcare Provider Details

I. General information

NPI: 1902923980
Provider Name (Legal Business Name): EYRA ADJOA AGUDU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 HAGER ST
SAINT MARYS OH
45885-2422
US

IV. Provider business mailing address

1140 S KNOXVILLE AVE STE D
SAINT MARYS OH
45885-2609
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-7311
  • Fax: 419-394-7313
Mailing address:
  • Phone: 419-300-1129
  • Fax: 419-394-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number202203076
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35074181
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: