1275791451 NPI number — DR. JOSEPHINE MOKONOGHO MD

Table of content: DR. JOSEPHINE MOKONOGHO MD (NPI 1275791451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275791451 NPI number — DR. JOSEPHINE MOKONOGHO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOKONOGHO
Provider First Name:
JOSEPHINE
Provider Middle Name:
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:
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:
1275791451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 W 14TH ST
Provider Second Line Business Mailing Address:
STE 1E40
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-1013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-320-2100
Provider Business Mailing Address Fax Number:
302-320-2121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHIATRY
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27157-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-716-4551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2008

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: 2084P0800X , with the licence number:  C1-0013564 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0015X , with the licence number: MD 442619 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0015X , with the licence number: C1-0013564 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1275791451 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275791451 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275791451 . This is a "UBH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275791451 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1275791541 . This is a "SANDHILLS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: Q0005M . This is a "SC MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275791451 . This is a "CENTERPOINT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1275791451 . This is a "CAROLINA BEHAVIORAL HEALTH AL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 277901 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9695720 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3385556 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 185TR . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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