Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 01075780A | IN |
N | 2080P0201X | Pediatric Allergist | 01075780 | IN |
NPI | 1255646220 |
---|---|
Provider Name | Noah Ojonugwa Agada |
First Address | Carmel, IN 46032-7265 |
Second Address | Carmel, IN 46032-7265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 18/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201397640 | (05) | IN |