Healthcare Provider Details

I. General information

NPI: 1831899327
Provider Name (Legal Business Name): MRS. OGECHI LILIAN OGBOLU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS OGECHI LILIAN OKORO

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

3264 KAISER DR
ELLICOTT CITY MD
21043-4555
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2000
  • Fax:
Mailing address:
  • Phone: 410-206-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR223651
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: