Healthcare Provider Details

I. General information

NPI: 1982967485
Provider Name (Legal Business Name): CHINWE OBIAGA MAHALEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W BELVEDERE AVE STE 402
BALTIMORE MD
21215-5231
US

IV. Provider business mailing address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9300
  • Fax: 410-601-9499
Mailing address:
  • Phone: 410-601-9300
  • Fax: 410-601-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0080033
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: