Provider Demographics
NPI:1952925596
Name:ABEDUO, OMONIIGHO PATRICK
Entity Type:Individual
Prefix:
First Name:OMONIIGHO
Middle Name:PATRICK
Last Name:ABEDUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 NAHANT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-3133
Mailing Address - Country:US
Mailing Address - Phone:443-447-8739
Mailing Address - Fax:
Practice Address - Street 1:6016 NAHANT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-3133
Practice Address - Country:US
Practice Address - Phone:443-447-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist