Healthcare Provider Details

I. General information

NPI: 1497015820
Provider Name (Legal Business Name): CHINWE OBIAKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 GEORGIA AVE NW
WASHINGTON DC
20012-1608
US

IV. Provider business mailing address

2040 BRIGADIER BLVD
ODENTON MD
21113-1038
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-6973
  • Fax:
Mailing address:
  • Phone: 301-395-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: