Healthcare Provider Details

I. General information

NPI: 1194772905
Provider Name (Legal Business Name): EDWARD OBAZEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N EUTAW ST
BALTIMORE MD
21201-4648
US

IV. Provider business mailing address

PO BOX 356
BALTIMORE MD
21203-0356
US

V. Phone/Fax

Practice location:
  • Phone: 410-206-3839
  • Fax: 410-664-4031
Mailing address:
  • Phone: 410-206-3839
  • Fax: 410-664-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD41430
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: