Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 286986 | MA |
NPI | 1205325800 |
---|---|
Provider Name | Ogorchukwu Faith Omede |
First Address | Revere, MA 02151-3770 |
Second Address | Boston, MA 02114-2696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 19/08/2021 |