Healthcare Provider Details

I. General information

NPI: 1083297444
Provider Name (Legal Business Name): ANNABEL CHISOM UMEH MB BCH BAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W. PRATT STREET ROOM 474
BALTIMORE MD
21201
US

IV. Provider business mailing address

701 W. PRATT STREET ROOM 474
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6325
  • Fax:
Mailing address:
  • Phone: 410-328-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0103139
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: