1831899327 NPI number — MRS. OGECHI LILIAN OGBOLU

Table of content: MRS. OGECHI LILIAN OGBOLU (NPI 1831899327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831899327 NPI number — MRS. OGECHI LILIAN OGBOLU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGBOLU
Provider First Name:
OGECHI
Provider Middle Name:
LILIAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OKORO
Provider Other First Name:
OGECHI
Provider Other Middle Name:
LILIAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831899327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3264 KAISER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21043-4555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-206-3227
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2023

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: 363LA2200X , with the licence number:  R223651 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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