Provider Demographics
NPI:1366413403
Name:OWENS-AGBEIBOR, CATRELL (MD)
Entity type:Individual
Prefix:DR
First Name:CATRELL
Middle Name:
Last Name:OWENS-AGBEIBOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATRELL
Other - Middle Name:
Other - Last Name:OWENS-AGBEIBOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5249 OLDE TOWNE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8111
Mailing Address - Country:US
Mailing Address - Phone:757-259-3258
Mailing Address - Fax:757-220-1953
Practice Address - Street 1:5249 OLDE TOWNE RD
Practice Address - Street 2:SUITE D
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8111
Practice Address - Country:US
Practice Address - Phone:757-259-3258
Practice Address - Fax:757-220-1953
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100036390AMedicaid
G78916Medicare UPIN
245508302Medicare ID - Type Unspecified