Individual
OBIAGHANWA S UGBANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25500 POINT LOOKOUT RD FL 1, LEONARDTOWN, MD 20650
(240) 434-7154
(301) 475-6190
Mailing address
25500 POINT LOOKOUT RD FL 1, LEONARDTOWN, MD 20650-2015
(240) 434-7154
(301) 475-6190
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35075907
OH
208000000X
Pediatrics Physician
Primary
D88070
MD
208M00000X
Hospitalist Physician
35.075907
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1807260000
MEDICAID
WV
05
—
2184890
—
OH
01
—
64036684
MEDICAID
KY
Enumeration date
10/12/2005
Last updated
12/03/2019
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