Provider Demographics
NPI:1730177866
Name:UGBANA, OBIAGHANWA S (MD)
Entity type:Individual
Prefix:
First Name:OBIAGHANWA
Middle Name:S
Last Name:UGBANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25500 POINT LOOKOUT RD FL 1
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2015
Mailing Address - Country:US
Mailing Address - Phone:240-434-7154
Mailing Address - Fax:301-475-6190
Practice Address - Street 1:25500 POINT LOOKOUT RD FL 1
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:240-434-7154
Practice Address - Fax:301-475-6190
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35075907208000000X
OH35.075907208M00000X
MDD88070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807260000OtherMEDICAID
KY64036684OtherMEDICAID
OH2184890Medicaid
OH2184890Medicaid
KY64036684OtherMEDICAID