Healthcare Provider Details

I. General information

NPI: 1366413403
Provider Name (Legal Business Name): CATRELL OWENS-AGBEIBOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATRELL OWENS-AGBEIBOR MD

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5249 OLDE TOWNE RD SUITE D
WILLIAMSBURG VA
23188-8111
US

IV. Provider business mailing address

5249 OLDE TOWNE RD SUITE D
WILLIAMSBURG VA
23188-8111
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-3258
  • Fax: 757-220-1953
Mailing address:
  • Phone: 757-259-3258
  • Fax: 757-220-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101245987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: