1093926206 NPI number — JOSEPH V.I. OSUAGWU, MD, PC

Table of content: (NPI 1093926206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093926206 NPI number — JOSEPH V.I. OSUAGWU, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH V.I. OSUAGWU, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GOODTIME FAMILY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093926206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5805 MORAVIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21206-6133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-325-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7131 LIBERTY RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GWYNN OAK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21207-4580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-325-5700
Provider Business Practice Location Address Fax Number:
410-325-5765
Provider Enumeration Date:
05/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERRY
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
410-325-5700

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 819601000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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