Provider Demographics
NPI:1205324225
Name:MIN-OBGYN OF MARYLAND PC
Entity type:Organization
Organization Name:MIN-OBGYN OF MARYLAND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:NETTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-856-0334
Mailing Address - Street 1:10401 HOSPITAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10401 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735
Practice Address - Country:US
Practice Address - Phone:301-856-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC94080002OtherBLUE CROSS