Provider Demographics
NPI:1790714657
Name:OBICHERE, ANTHONIA EGO (CNM)
Entity Type:Individual
Prefix:
First Name:ANTHONIA
Middle Name:EGO
Last Name:OBICHERE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1189
Mailing Address - Country:US
Mailing Address - Phone:301-618-2243
Mailing Address - Fax:
Practice Address - Street 1:7582 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1744
Practice Address - Country:US
Practice Address - Phone:301-618-1550
Practice Address - Fax:301-429-1873
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR067920367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
722723P76Medicare ID - Type UnspecifiedRENDERING # DIMENSIONS
S39006Medicare UPIN