MEDICARE: DR. PRECIOUS OFODILE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	125079329	IL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	345559	NY

General Provider Information

NPI Number	:	1174263552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRECIOUS OFODILE MD

Provider Business Mailing Address
First Line	:	6529 SPRING BROOK AVE
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3709
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6529 SPRING BROOK AVE
Second Line	:
City	:	RHINEBECK
State	:	NY
Zip	:	12572-3709
Country	:	US
Telephone Number	:	845-876-4745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	06/16/2026

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