1184697070 NPI number — DR. MARTINA C OGBONNA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184697070 NPI number — DR. MARTINA C OGBONNA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGBONNA
Provider First Name:
MARTINA
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EKECHUKWU-OGBONNA
Provider Other First Name:
MARTINA
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184697070
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 1101
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-441-0006
Provider Business Mailing Address Fax Number:
713-790-2727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6550 FANNIN ST
Provider Second Line Business Practice Location Address:
SUITE 1101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-441-0006
Provider Business Practice Location Address Fax Number:
713-790-2727
Provider Enumeration Date:
02/10/2006

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: 207Q00000X , with the licence number:  N9927 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 043670 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N9927 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 043670 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: N9927 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001436709 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288807503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8EE938 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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