Healthcare Provider Details

I. General information

NPI: 1275917577
Provider Name (Legal Business Name): CHRISTOPHER DUAKA OBIOGBOLU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5639
US

IV. Provider business mailing address

6800 MCCORMICK RD
UPPER MARLBORO MD
20772-4351
US

V. Phone/Fax

Practice location:
  • Phone: 240-633-6156
  • Fax:
Mailing address:
  • Phone: 410-900-8888
  • Fax: 469-932-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR181376
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR181376
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: