MEDICARE: DR. PAUL OGBURN JR.

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	207VM0101X	Maternal & Fetal Medicine Physician	220748	NY

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	:	1992706923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL OGBURN JR.

Provider Business Mailing Address
First Line	:	200 BELLE TERRE RD
Second Line	:
City	:	PORT JEFFERSON
State	:	NY
Zip	:	11777
Country	:	US
Telephone Number	:	631-474-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 YOUNGS RD STE 110
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14221-2698
Country	:	US
Telephone Number	:	716-852-4772
Fax Number	:

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	02/23/2021

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