Healthcare Provider Details

I. General information

NPI: 1295813020
Provider Name (Legal Business Name): VERONICA C. OBODO-ECKBLAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA C. OBODO MD

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 GEORGIA AVE
SILVER SPRING MD
20910-4519
US

IV. Provider business mailing address

1111 N CHARLES ST
BALTIMORE MD
21201-5505
US

V. Phone/Fax

Practice location:
  • Phone: 301-960-4682
  • Fax:
Mailing address:
  • Phone: 410-837-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA86492
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0095699
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: