Provider Demographics
NPI:1730219981
Name:OGOLO, CLINTON HEZEKIAH (MD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:HEZEKIAH
Last Name:OGOLO
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 1:1457 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08609-1909
Mailing Address - Country:US
Mailing Address - Phone:609-586-3828
Mailing Address - Fax:609-586-9466
Practice Address - Street 1:1457 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1909
Practice Address - Country:US
Practice Address - Phone:609-586-3828
Practice Address - Fax:609-586-9466
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA60771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1022197OtherHORIZON NJ HEALTH
NJ24400OtherAMERIGROUP
NJP1094258OtherOXFORD
NJ00349315OtherPENNSYLVANIA BC BS
NJ0037114001OtherAMERIHEALTH
NJ15542OtherUNIVERSITY HEALTH PLAN
NJ6077100OtherMANAGE CARE
NJ0K1372OtherHEALTH NET
NJ349315OtherKEYSTONE HEALTH PLAN EAST
NJ6514901Medicaid
NJ893850OtherCIGNA
531742OtherAETNA
NJ0037114001OtherAMERIHEALTH
NJ893850OtherCIGNA