Provider Demographics
NPI:1427058361
Name:OKUWOBI, OBAFEMI (MD)
Entity type:Individual
Prefix:
First Name:OBAFEMI
Middle Name:
Last Name:OKUWOBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6797
Mailing Address - Country:US
Mailing Address - Phone:301-714-4400
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-714-4400
Practice Address - Fax:301-714-4424
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00703367207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000913173Medicaid
MD416128YVZMedicare PIN
MD416128ZDDBMedicare PIN
GA08BBVNNMedicare PIN
MD177945YWV2Medicare PIN