Provider Demographics
NPI:1902942931
Name:NWOSU, AGODICHI U (MD)
Entity Type:Individual
Prefix:
First Name:AGODICHI
Middle Name:U
Last Name:NWOSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S MCPHERSON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5350
Mailing Address - Country:US
Mailing Address - Phone:910-483-0018
Mailing Address - Fax:
Practice Address - Street 1:909 S MCPHERSON CHURCH RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5350
Practice Address - Country:US
Practice Address - Phone:910-483-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001224207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128AAOtherBCBC-NC INDIV
NC89128AAMedicaid
NC128AAOtherBCBC-NC INDIV
NC89128AAMedicaid
NC2282822AMedicare ID - Type UnspecifiedMEDICARE INDIV