Healthcare Provider Details

I. General information

NPI: 1366061251
Provider Name (Legal Business Name): KATHRYN MARIE OGBORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BELMONT AVE
YOUNGSTOWN OH
44504-1006
US

IV. Provider business mailing address

1393 CONCORD POINT LN
RESTON VA
20194-1307
US

V. Phone/Fax

Practice location:
  • Phone: 330-480-2371
  • Fax:
Mailing address:
  • Phone: 240-638-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1366061251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: