Provider Demographics
NPI:1780775346
Name:OBENG, SIMEON KWAME (MD)
Entity type:Individual
Prefix:DR
First Name:SIMEON
Middle Name:KWAME
Last Name:OBENG
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 1:3288 ELMMEDE RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2300
Mailing Address - Country:US
Mailing Address - Phone:410-418-9233
Mailing Address - Fax:202-561-1500
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-561-2122
Practice Address - Fax:202-561-1500
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034243207R00000X
MDD0057495207R00000X
IL207R00000X
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H43141Medicare UPIN