1356572879 NPI number — NOSAYABA AGIDIGBI MD

Table of content: NOSAYABA AGIDIGBI MD (NPI 1356572879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356572879 NPI number — NOSAYABA AGIDIGBI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGIDIGBI
Provider First Name:
NOSAYABA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356572879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5450 FRANTZ RD STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43016-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-566-8883
Provider Business Mailing Address Fax Number:
614-566-8149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MCKINLEY PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43302-6399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-566-8883
Provider Business Practice Location Address Fax Number:
614-566-8149
Provider Enumeration Date:
07/31/2009

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:  35.093890 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 35093890 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 35.093890 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2979282 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: H113469 . This is a "MEDICARE OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".