Provider Demographics
NPI:1639437403
Name:OBAMIRO, EUNICE (MD)
Entity type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:
Last Name:OBAMIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5800
Mailing Address - Country:US
Mailing Address - Phone:856-691-3300
Mailing Address - Fax:
Practice Address - Street 1:1317 S MAIN RD STE 2A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6511
Practice Address - Country:US
Practice Address - Phone:856-553-8724
Practice Address - Fax:856-348-5110
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12627400207R00000X
NJ26NJ00373000363LF0000X
MI4301512520207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program