Provider Demographics
NPI:1700311776
Name:OFOCHE, OBINNA
Entity type:Individual
Prefix:
First Name:OBINNA
Middle Name:
Last Name:OFOCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 HEATER RD
Mailing Address - Street 2:APT G
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 HEATER RD
Practice Address - Street 2:APT G
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1431
Practice Address - Country:US
Practice Address - Phone:603-729-6887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313213208M00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist