Healthcare Provider Details

I. General information

NPI: 1518514371
Provider Name (Legal Business Name): MOSES OBURA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 N ROLLING RD STE 304
CATONSVILLE MD
21228-4133
US

IV. Provider business mailing address

1589 SULPHUR SPRING RD STE 109
BALTIMORE MD
21227-2542
US

V. Phone/Fax

Practice location:
  • Phone: 410-744-0890
  • Fax: 410-744-2007
Mailing address:
  • Phone: 410-536-5400
  • Fax: 410-737-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberR207580
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR207580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: