Provider Demographics
NPI:1760195762
Name:OMOBUDE, MEAGHON
Entity Type:Individual
Prefix:
First Name:MEAGHON
Middle Name:
Last Name:OMOBUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 CEDAR FOREST DR APT I
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7703
Mailing Address - Country:US
Mailing Address - Phone:804-721-2985
Mailing Address - Fax:
Practice Address - Street 1:1525 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3706
Practice Address - Country:US
Practice Address - Phone:202-745-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health