1619234598 NPI number — ADISA OLUTOYIN AYEGBAJEJE HHA

Table of content: ADISA OLUTOYIN AYEGBAJEJE HHA (NPI 1619234598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619234598 NPI number — ADISA OLUTOYIN AYEGBAJEJE HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYEGBAJEJE
Provider First Name:
ADISA
Provider Middle Name:
OLUTOYIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
HHA
Provider Gender Code:
M

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:
1619234598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 ENDERS LN
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:
20716-7355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-806-8610
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 TAYLOR ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-464-9200
Provider Business Practice Location Address Fax Number:
202-291-2160
Provider Enumeration Date:
04/18/2012

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: 163W00000X , with the licence number:  RN200006206 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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