Provider Demographics
NPI:1447510953
Name:ABUGO, USIWOMA ESENIGHE ENE (MD)
Entity type:Individual
Prefix:
First Name:USIWOMA
Middle Name:ESENIGHE ENE
Last Name:ABUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 YORK RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6220
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:
Practice Address - Street 1:1209 YORK RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6220
Practice Address - Country:US
Practice Address - Phone:410-821-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0098646207WX0200X, 207W00000X, 207WX0109X
NJ25MA11783500207W00000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA206767Medicare PIN