Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2005-01139 | NC |
Y | 111NI0900X | Internist | 2005-01139 | NC |
N | 207RC0200X | Critical Care Medicine | 2005-01139 | NC |
NPI | 1043300858 |
---|---|
Provider Name | Osaguona Osa |
First Address | Charlotte, NC 28260-1884 |
Second Address | Shelby, NC 28150-3917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 15/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901437 | (05) | NC |
I37188 | (02) | NC |
NUP361 | (05) | SC |