Individual
MICHAEL OGBOLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 LIBERTY HEIGHTS AVE, BALTIMORE, MD 21215-7804
(410) 383-4615
(410) 383-4606
Mailing address
2600 LIBERTY HEIGHTS AVE, BALTIMORE, MD 21215-7804
(410) 383-4615
(410) 383-4606
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2ID0918551
CLIA#
—
Enumeration date
04/20/2007
Last updated
07/08/2007
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