Healthcare Provider Details

I. General information

NPI: 1376003566
Provider Name (Legal Business Name): OSINAKACHUKWU MBATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OHSU 3181 SW SAM JACKSON PARK ROAD
PORTLAND OR
97239
US

IV. Provider business mailing address

OHSU 3181 SW SAM JACKSON PARK ROAD
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8211
  • Fax:
Mailing address:
  • Phone: 503-494-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number111633
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number111633
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: