Provider Demographics
NPI:1083925945
Name:UGA, AGHAEGBULAM HARACHI (MD)
Entity type:Individual
Prefix:
First Name:AGHAEGBULAM
Middle Name:HARACHI
Last Name:UGA
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 1:1700 CURIE DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2981
Mailing Address - Country:US
Mailing Address - Phone:915-200-1144
Mailing Address - Fax:915-703-7668
Practice Address - Street 1:1700 CURIE DR STE 2100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2981
Practice Address - Country:US
Practice Address - Phone:915-200-1144
Practice Address - Fax:915-703-7668
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ4867207R00000X, 2084P0800X
IL125.058546207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine