1588895411 NPI number — OLAYINKA ABIMBOLA IBITOYE NP

Table of content: OLAYINKA ABIMBOLA IBITOYE NP (NPI 1588895411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588895411 NPI number — OLAYINKA ABIMBOLA IBITOYE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IBITOYE
Provider First Name:
OLAYINKA
Provider Middle Name:
ABIMBOLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588895411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14011 WESTVIEW FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20720-4867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-352-4014
Provider Business Mailing Address Fax Number:
240-245-4409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12200 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
SUITE 232
Provider Business Practice Location Address City Name:
GLENN DALE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20769-9182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-245-4414
Provider Business Practice Location Address Fax Number:
240-245-4409
Provider Enumeration Date:
07/27/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R145692 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)