Provider Demographics
NPI:1558955054
Name:OPARA, LYDIA EMUOBOSA (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:EMUOBOSA
Last Name:OPARA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 CARLYN RIDGE RD # A
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2157
Mailing Address - Country:US
Mailing Address - Phone:240-595-2225
Mailing Address - Fax:
Practice Address - Street 1:7325 HANOVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3618
Practice Address - Country:US
Practice Address - Phone:301-220-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199706363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR199706Medicaid