MEDICARE: PATRICK IFEANYI OBIORA OGBONNA

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	225000000X	Orthotic Fitter
2	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist

General Provider Information

NPI Number	:	1760786271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK IFEANYI OBIORA OGBONNA

Provider Business Mailing Address
First Line	:	1801 SAINT ALBANS DR STE G
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6286
Country	:	US
Telephone Number	:	919-876-4949
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 SAINT ALBANS DR STE G
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-6286
Country	:	US
Telephone Number	:	919-876-4949
Fax Number	:

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

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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