MEDICARE: MR. ANYA ONUOHA ODIM

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	103T00000X	Psychologist	2596	NC
2	103TB0200X	Cognitive & Behavioral Psychologist	2596	NC
3	103TC0700X	Clinical Psychologist	2596	NC
4	103TC2200X	Clinical Child & Adolescent Psychologist	2596	NC
5	103TH0100X	Health Service Psychologist	2596	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306910781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANYA ONUOHA ODIM

Provider Business Mailing Address
First Line	:	4520 SHADY SIDE LN
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-3127
Country	:	US
Telephone Number	:	919-451-6337
Fax Number	:	919-484-1125

Provider Business Practice Location Address
First Line	:	3500 WESTGATE DR
Second Line	:	SUITE 604
City	:	DURHAM
State	:	NC
Zip	:	27707-2567
Country	:	US
Telephone Number	:	919-451-6337
Fax Number	:	919-484-1125

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/21/2013

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