Organization
MIN-OBGYN OF MARYLAND PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EBENEZER NETTEY MD (CEO/MD)
(301) 856-0334
Entity
Organization
Contact information
Practice address
10401 HOSPITAL DRIVE, SUITE 103, CLINTON, MD 20735
(301) 856-0334
Mailing address
10401 HOSPITAL DR STE 103, CLINTON, MD 20735-3150
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94080002
BLUE CROSS
DC
Enumeration date
04/25/2018
Last updated
04/25/2018
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