Physician Compare National (NPI:1093890535)

HEALTHCARE PROVIDER: TAGBO JOHN EKWONU M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1093890535
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6305936444
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071213000292
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EKWONU
	Individual professional last name
Provider First Name	TAGBO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4115 THE PLAZA
	Group Practice or individual's line 1 address
City	CHARLOTTE
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	282051356
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y