Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 200401554 | NC |
N | 111NI0900X | Internist | 200401554 | NC |
N | 207RH0002X | Hospice and Palliative Medicine | 200401554 | NC |
Y | 207RN0300X | Nephrologist | 200401554 | NC |
NPI | 1346209707 |
---|---|
Provider Name | Dr. Sylvester Izuchukwu Ogbata |
First Address | Waxhaw, NC 28173-9817 |
Second Address | Charlotte, NC 28205-5624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 23/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2039189 | (02) | NC |
5900398 | (05) | NC |
N01554 | (05) | SC |