Healthcare Provider Details

I. General information

NPI: 1124872742
Provider Name (Legal Business Name): LINA OBEIDAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST RM S2A19
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

2101 16TH ST NW APT 214
WASHINGTON DC
20009-6583
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3477
  • Fax: 410-328-1190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberD0108238
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0108238
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: