Provider Demographics
NPI:1922265529
Name:OBIADI, JENNIFER ENUKA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ENUKA
Last Name:OBIADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR # 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:410-933-1390
Practice Address - Street 1:14207 PARK CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-604-5254
Practice Address - Fax:410-367-2093
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD68005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty