Healthcare Provider Details

I. General information

NPI: 1831417211
Provider Name (Legal Business Name): ADAOBI NWANESHIUDU OBASI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADAOBI I NWANESHIUDU M.D

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 JACAMAN RD STE 101
LAREDO TX
78041-6271
US

IV. Provider business mailing address

1601 JACAMAN RD STE 101
LAREDO TX
78041-6271
US

V. Phone/Fax

Practice location:
  • Phone: 956-608-3071
  • Fax: 956-608-3033
Mailing address:
  • Phone: 956-608-3071
  • Fax: 956-608-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD453983
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number036.134644
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberQ9871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: