Healthcare Provider Details

I. General information

NPI: 1689243354
Provider Name (Legal Business Name): MURRAY IYKE OBANYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 REISTERSTOWN RD STE 302
BALTIMORE MD
21215-2689
US

IV. Provider business mailing address

6615 REISTERSTOWN RD STE 302
BALTIMORE MD
21215-2689
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-4263
  • Fax: 410-580-2037
Mailing address:
  • Phone: 410-383-4263
  • Fax: 410-580-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR180800
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: