Basic Information
| Provider Information | |||||||||
| NPI: | 1952651309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGBONAVBARE | ||||||||
| FirstName: | PATIENCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E CARROLL ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105466400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 E CARROLL ST | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105437536 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101270712 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | CV2005240 | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 26587 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT201020 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101270712 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | D82498 | MD | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.