Healthcare Provider Details

I. General information

NPI: 1033514666
Provider Name (Legal Business Name): OBINNA EGO-OSUALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 HANOVER PKWY STE 203
GREENBELT MD
20770-2009
US

IV. Provider business mailing address

7500 HANOVER PKWY STE 203
GREENBELT MD
20770-2009
US

V. Phone/Fax

Practice location:
  • Phone: 301-895-7337
  • Fax:
Mailing address:
  • Phone: 301-895-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD81089
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: