1114307048 NPI number — DR. ROSELINE OGOCHUKWU OKIGBO D.O.

Table of content: DR. ROSELINE OGOCHUKWU OKIGBO D.O. (NPI 1114307048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114307048 NPI number — DR. ROSELINE OGOCHUKWU OKIGBO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKIGBO
Provider First Name:
ROSELINE
Provider Middle Name:
OGOCHUKWU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ODI
Provider Other First Name:
OGONNA
Provider Other Middle Name:
IJEOMA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114307048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 VALLEY PARK S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18018-1328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-717-1349
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 OSTRUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-526-4644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OT016361 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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