Provider Demographics
NPI:1083796452
Name:OBIDI, CHUKWUEMEKA (MD)
Entity Type:Individual
Prefix:
First Name:CHUKWUEMEKA
Middle Name:
Last Name:OBIDI
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 1:303 MEMORIAL BLVD W
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:301-791-7060
Mailing Address - Fax:301-791-8990
Practice Address - Street 1:303 MEMORIAL BLVD W
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740
Practice Address - Country:US
Practice Address - Phone:301-791-7060
Practice Address - Fax:301-791-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410471400Medicaid