Provider Demographics
NPI:1295813020
Name:OBODO-ECKBLAD, VERONICA C (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:C
Last Name:OBODO-ECKBLAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:C
Other - Last Name:OBODO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5505
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:
Practice Address - Street 1:8206 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4519
Practice Address - Country:US
Practice Address - Phone:301-960-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86492207Q00000X
MDD0095699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1588606305Medicaid
CA00A864920Medicaid
I43248Medicare UPIN