Healthcare Provider Details

I. General information

NPI: 1881589406
Provider Name (Legal Business Name): GILBERT ETTA OBEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 HENNEPIN CT
HANOVER MD
21076-1761
US

IV. Provider business mailing address

7701 HENNEPIN CT
HANOVER MD
21076-1761
US

V. Phone/Fax

Practice location:
  • Phone: 301-326-5436
  • Fax:
Mailing address:
  • Phone: 301-326-5436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: