Provider Demographics
NPI:1538430301
Name:MUOGHALU, MARIA-PEREZ AGIN (MBBS)
Entity type:Individual
Prefix:DR
First Name:MARIA-PEREZ
Middle Name:AGIN
Last Name:MUOGHALU
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:MARIA-PEREZ
Other - Middle Name:AGIN
Other - Last Name:BUBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:3827 DUNSINANE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2649
Mailing Address - Country:US
Mailing Address - Phone:202-509-2851
Mailing Address - Fax:
Practice Address - Street 1:4500 PARSONS BLVD
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2205
Practice Address - Country:US
Practice Address - Phone:718-670-5000
Practice Address - Fax:718-670-4510
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12122207R00000X, 208M00000X
NY271722208M00000X
OH35.121849207R00000X
MDD077370207R00000X
DCMD043776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist