Provider Demographics
NPI:1376771279
Name:OBI, EVANGELINE C (MD)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:C
Last Name:OBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:C
Other - Last Name:NDIGWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10001 HALLMARK CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2580
Mailing Address - Country:US
Mailing Address - Phone:301-547-5821
Mailing Address - Fax:
Practice Address - Street 1:2900 MERCY LN
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1157
Practice Address - Country:US
Practice Address - Phone:301-851-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116021225207Q00000X
WI57434207Q00000X
VA0101257953208M00000X
MDD0080483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD581045100Medicaid
WI57434OtherWI STATE LICENSE