Individual
OSITA IBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 LOCUST ST, CAMBRIDGE, MD 21613-1701
(240) 421-4882
Mailing address
601 LOCUST ST, CAMBRIDGE, MD 21613-1701
(240) 421-4882
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R222210
MD
164W00000X
Licensed Practical Nurse
Primary
LP48867
MD
Other
Enumeration date
01/11/2017
Last updated
01/11/2017
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