Healthcare Provider Details

I. General information

NPI: 1295699304
Provider Name (Legal Business Name): OBEN GLADYS BESSONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11709 PHILADELPHIA RD
WHITE MARSH MD
21162-1153
US

IV. Provider business mailing address

11709 PHILADELPHIA RD
WHITE MARSH MD
21162-1153
US

V. Phone/Fax

Practice location:
  • Phone: 410-947-3052
  • Fax:
Mailing address:
  • Phone: 410-947-3052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025047532
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: