Provider Demographics
NPI:1235224270
Name:OBIOHA, CHARLES AFAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:AFAM
Last Name:OBIOHA
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 1:11400 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3004
Mailing Address - Country:US
Mailing Address - Phone:301-770-3334
Mailing Address - Fax:301-770-3336
Practice Address - Street 1:11400 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3004
Practice Address - Country:US
Practice Address - Phone:301-770-3334
Practice Address - Fax:301-770-3336
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG10391Medicare UPIN
MDG01682D01Medicare ID - Type Unspecified