MEDICARE: DR. LAWRENCE OGBOGU APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70105644	WA
2	363LF0000X	Family Nurse Practitioner	12.006518	CT
3	363LF0000X	Family Nurse Practitioner	AP70105644	WA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	406267	NY
5	363L00000X	Nurse Practitioner	6518	CT
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	12.006518	CT
7	363LF0000X	Family Nurse Practitioner	347647	NY

General Provider Information

NPI Number	:	1760846042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE OGBOGU APRN

Provider Business Mailing Address
First Line	:	19 OLD SCHOOLHOUSE RD
Second Line	:
City	:	PROSPECT
State	:	CT
Zip	:	06712-1210
Country	:	US
Telephone Number	:	203-543-2873
Fax Number	:	203-919-0050

Provider Business Practice Location Address
First Line	:	1279 W MAIN ST
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06708-3101
Country	:	US
Telephone Number	:	203-755-5490
Fax Number	:

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

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	03/23/2026

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