Healthcare Provider Details

I. General information

NPI: 1669926309
Provider Name (Legal Business Name): MR. FRANKLINE NGOZI OBI I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 HIGHLAND MEADOWS DR
CLINTON MD
20735
US

IV. Provider business mailing address

8111 HIGHLAND MEADOWS DR
CLINTON MD
20735-1871
US

V. Phone/Fax

Practice location:
  • Phone: 301-265-6343
  • Fax:
Mailing address:
  • Phone: 301-265-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12204
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: