MEDICARE: ERIC KOBENA SAFO NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP500004284	DC
2	363LF0000X	Family Nurse Practitioner	NP500004284	DC
3	363LF0000X	Family Nurse Practitioner	R204606	MD

General Provider Information

NPI Number	:	1629654165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC KOBENA SAFO NP

Provider Business Mailing Address
First Line	:	20217 GENTLE WAY
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20886-1204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3611 BRANCH AVE STE 404
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-1251
Country	:	US
Telephone Number	:	240-719-2587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	02/06/2026

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