Healthcare Provider Details

I. General information

NPI: 1861266835
Provider Name (Legal Business Name): AFOMA P OBIOGBOLU PMHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 ALLENTOWN RD STE B
SUITLAND MD
20746-4570
US

IV. Provider business mailing address

6800 MCCORMICK RD
UPPER MARLBORO MD
20772-4351
US

V. Phone/Fax

Practice location:
  • Phone: 240-899-5314
  • Fax:
Mailing address:
  • Phone: 240-899-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR239206
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1054227
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR239206
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number030175
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR239206
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1054227
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: