Individual
PETER OBENG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4390 WELSH LN APT 11, WOODBRIDGE, VA 22193-5667
(571) 477-8936
Mailing address
4390 WELSH LN APT 11, WOODBRIDGE, VA 22193-5667
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A61315630
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1044
CONTRACT CARRIER
VA
Enumeration date
03/21/2018
Last updated
03/21/2018
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