1023070547 NPI number — DONATUS OGU M.D.

Table of content: (NPI 1619159506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023070547 NPI number — DONATUS OGU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGU
Provider First Name:
DONATUS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023070547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28034-0578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-923-0446
Provider Business Mailing Address Fax Number:
704-923-8319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 N SUMMEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28034-1824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-923-0446
Provider Business Practice Location Address Fax Number:
704-923-8319
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  9300555 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 76743 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110159213 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8910826 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116085 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21564 . This is a "PARTNERS/PARTNERS MEDICAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 441733 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1184723 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 253704 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10826 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: N0055C . This is a "SOUTH CAROLINA MEDICAID" identifier . This identifiers is of the category "OTHER".




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