1457495830 NPI number — DR. KUDIRATU ARANMOLATE CLARK MD

Table of content: DR. KUDIRATU ARANMOLATE CLARK MD (NPI 1457495830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457495830 NPI number — DR. KUDIRATU ARANMOLATE CLARK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK
Provider First Name:
KUDIRATU
Provider Middle Name:
ARANMOLATE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARANMOLATE
Provider Other First Name:
KUDIRATU
Provider Other Middle Name:
ATINUKE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457495830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2730 UNIVERSITY BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20902-1979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-942-8799
Provider Business Mailing Address Fax Number:
301-933-8554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 UNIVERSITY BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20902-1979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-942-8799
Provider Business Practice Location Address Fax Number:
301-933-8554
Provider Enumeration Date:
02/17/2007

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: 207L00000X , with the licence number:  D0070652 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 69565 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com