Healthcare Provider Details

I. General information

NPI: 1902252323
Provider Name (Legal Business Name): TAKUYA OGAMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date: 01/03/2017
Reactivation Date: 01/23/2017

III. Provider practice location address

120 E 2ND ST
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST
ERIE PA
16507-1537
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD485482
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: