Provider Demographics
NPI:1760478119
Name:UGAH, NWANNADIYA GLORY (MD)
Entity type:Individual
Prefix:
First Name:NWANNADIYA
Middle Name:GLORY
Last Name:UGAH
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 1:2600 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-272-3051
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:101 N BOND ST
Practice Address - Street 2:
Practice Address - City:ROWLAND
Practice Address - State:NC
Practice Address - Zip Code:28383-9741
Practice Address - Country:US
Practice Address - Phone:910-422-3350
Practice Address - Fax:910-422-3936
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1155HOtherBCBS
NC891155HMedicaid
NC2265313GMedicare PIN
NC2265313HMedicare PIN
NC891155HMedicaid
NC2265313FMedicare PIN
NCG83568Medicare UPIN