Provider Demographics
NPI:1174110431
Name:OBI, THERESA CHILOGHA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:CHILOGHA
Last Name:OBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 CIPRIANO WOODS CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3829
Mailing Address - Country:US
Mailing Address - Phone:240-330-2279
Mailing Address - Fax:
Practice Address - Street 1:6902 CIPRIANO WOODS CT
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3829
Practice Address - Country:US
Practice Address - Phone:240-330-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223326363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care