Healthcare Provider Details

I. General information

NPI: 1558955054
Provider Name (Legal Business Name): LYDIA EMUOBOSA OPARA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13225 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2648
US

IV. Provider business mailing address

13225 EXECUTIVE PARK TER
GERMANTOWN MD
20874-2648
US

V. Phone/Fax

Practice location:
  • Phone: 301-337-9642
  • Fax: 888-347-2510
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR199706
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: