Healthcare Provider Details

I. General information

NPI: 1205437324
Provider Name (Legal Business Name): PATRICIA OGBEBOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 ROCK FOREST DR APT 102
BETHESDA MD
20817-7921
US

IV. Provider business mailing address

10440 LITTLE PATUXENT PKWY STE 800
COLUMBIA MD
21044-3569
US

V. Phone/Fax

Practice location:
  • Phone: 301-346-1247
  • Fax:
Mailing address:
  • Phone: 301-346-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1007194
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1007194
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: