Healthcare Provider Details

I. General information

NPI: 1932941226
Provider Name (Legal Business Name): EBERE OGBONNAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 WILLOW CREEK CT
BALTIMORE MD
21234-8715
US

IV. Provider business mailing address

12 WILLOW CREEK CT
BALTIMORE MD
21234-8743
US

V. Phone/Fax

Practice location:
  • Phone: 410-900-4201
  • Fax:
Mailing address:
  • Phone: 410-900-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP44506
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: