Basic Information
| Provider Information | |||||||||
| NPI: | 1518514371 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OBURA | ||||||||
| FirstName: | MOSES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3354 N CHATHAM RD APT J | ||||||||
| Address2: | |||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210422761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104964511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5401 OLD COURT RD | ||||||||
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| City: | RANDALLSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211335103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2019 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | R207580 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 208M00000X | R207580 | MD | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.