Provider Demographics
NPI:1649267352
Name:OBIADI, GABRIEL O (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:O
Last Name:OBIADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 7TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4011
Mailing Address - Country:US
Mailing Address - Phone:301-776-6121
Mailing Address - Fax:301-776-3860
Practice Address - Street 1:601 7TH ST STE 204
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4011
Practice Address - Country:US
Practice Address - Phone:301-776-6121
Practice Address - Fax:301-776-3860
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF97431Medicare UPIN