Healthcare Provider Details

I. General information

NPI: 1922265529
Provider Name (Legal Business Name): JENNIFER ENUKA OBIADI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 PARK CENTER DR SUITE 102
LAUREL MD
20707
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR # 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-5254
  • Fax: 410-367-2093
Mailing address:
  • Phone: 410-933-5412
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD68005
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: