Provider Demographics
NPI:1831417211
Name:OBASI, ADAOBI NWANESHIUDU (MD)
Entity type:Individual
Prefix:DR
First Name:ADAOBI
Middle Name:NWANESHIUDU
Last Name:OBASI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADAOBI
Other - Middle Name:I
Other - Last Name:NWANESHIUDU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1601 JACAMAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6271
Mailing Address - Country:US
Mailing Address - Phone:956-608-3071
Mailing Address - Fax:956-608-3033
Practice Address - Street 1:1601 JACAMAN RD STE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6271
Practice Address - Country:US
Practice Address - Phone:956-608-3071
Practice Address - Fax:956-608-3033
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453983207ND0900X
IL036.134644207ND0900X
TXQ9871207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366710702OtherCSHCN
TX366710701Medicaid
TX547081YK00Medicare UPIN