Provider Demographics
NPI:1134501471
Name:IGENE, OTIBHOR (MD)
Entity Type:Individual
Prefix:
First Name:OTIBHOR
Middle Name:
Last Name:IGENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 SILVER MOON CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3167
Mailing Address - Country:US
Mailing Address - Phone:443-834-0621
Mailing Address - Fax:
Practice Address - Street 1:7670 QUARTERFIELD RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3947
Practice Address - Country:US
Practice Address - Phone:410-508-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD87115207Q00000X
VA0101267165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine