Healthcare Provider Details

I. General information

NPI: 1023037165
Provider Name (Legal Business Name): CHRISTOPHER W OGBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 PUDDLEDOCK RD SUITE 300
PRINCE GEORGE VA
23875-1268
US

IV. Provider business mailing address

4700 PUDDLEDOCK RD SUITE 300
PRINCE GEORGE VA
23875-1268
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-1111
  • Fax: 804-526-2978
Mailing address:
  • Phone: 804-526-1111
  • Fax: 804-526-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101058042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: