1174070858 NPI number — CATHERINE ONOGIMENAJE OGUNSOLA

Table of content: CATHERINE ONOGIMENAJE OGUNSOLA (NPI 1174070858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174070858 NPI number — CATHERINE ONOGIMENAJE OGUNSOLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGUNSOLA
Provider First Name:
CATHERINE
Provider Middle Name:
ONOGIMENAJE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EHIEMUA
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
ONOGIMENAJE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174070858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20861-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-9700
Provider Business Mailing Address Fax Number:
301-260-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13238 EXECUTIVE PARK TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20874-2640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-813-3814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2016

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: 363LP0808X , with the licence number:  R205050 , 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)





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