Active NPI
Onyedika Moghalu, M.D.
- Neurology Physician
- College Station, TX
National Provider Identifier
1508209172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- T1156
- Practice address
- 1730 Birmingham Rd Ste 100
College Station, TX 77845-4063 - Phone
- (979) 690-4470
- NPI assigned
- Apr 12, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | T1156 | TX | Primary |
Addresses
Primary practice location
1730 Birmingham Rd Ste 100
College Station, TX 77845-4063
Mailing address
1730 Birmingham Rd Ste 100
College Station, TX 77845-4063
Phone (979) 690-4470
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430436201 | Medicaid | TX | |
| Q00258560 | Other | TX | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T1156 | TX | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1365724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661817600000",
"number": "1508209172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1730 BIRMINGHAM RD STE 100",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778454063",
"telephone_number": "979-690-4470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1730 BIRMINGHAM RD STE 100",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778454063",
"telephone_number": "979-690-4470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGHALU",
"first_name": "ONYEDIKA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-12",
"last_updated": "2022-08-30",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TX",
"license": "T1156",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "430436201",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "Q00258560",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.