MEDICARE: ADAOBI GBUGU PA-C

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	363AM0700X	Medical Physician Assistant		TX

General Provider Information

NPI Number	:	1730584202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAOBI GBUGU PA-C

Provider Business Mailing Address
First Line	:	15 HIGHLAND AVE
Second Line	:
City	:	MARS HILL
State	:	ME
Zip	:	04758-3133
Country	:	US
Telephone Number	:	207-768-4915
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 HIGHLAND AVE
Second Line	:
City	:	MARS HILL
State	:	ME
Zip	:	04758-3133
Country	:	US
Telephone Number	:	207-768-4915
Fax Number	:

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	04/20/2018

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