Healthcare Provider Details

I. General information

NPI: 1659283547
Provider Name (Legal Business Name): ALEXANDER OBEAHON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MARSHANE RD
REISTERSTOWN MD
21136-5860
US

IV. Provider business mailing address

1000 MARSHANE RD
REISTERSTOWN MD
21136-5860
US

V. Phone/Fax

Practice location:
  • Phone: 301-785-3633
  • Fax: 443-200-1582
Mailing address:
  • Phone: 301-785-3633
  • Fax: 443-200-1582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35368
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: