1609656958 NPI number — CAROLINE OLABISI ADU-AGBAJE RN

Table of content: CAROLINE OLABISI ADU-AGBAJE RN (NPI 1609656958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609656958 NPI number — CAROLINE OLABISI ADU-AGBAJE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADU-AGBAJE
Provider First Name:
CAROLINE
Provider Middle Name:
OLABISI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1609656958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7706 LEXINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-5835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-581-0324
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4017 MINNESOTA AVE NE
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:
20019-3541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-388-4303
Provider Business Practice Location Address Fax Number:
202-388-4332
Provider Enumeration Date:
10/04/2023

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: 163WP0808X , with the licence number:  RN1026925 , 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)





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