1811121734 NPI number — MS. OLUYEMISI ADEOLA KALEJAIYE PT

Table of content: MS. OLUYEMISI ADEOLA KALEJAIYE PT (NPI 1811121734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811121734 NPI number — MS. OLUYEMISI ADEOLA KALEJAIYE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALEJAIYE
Provider First Name:
OLUYEMISI
Provider Middle Name:
ADEOLA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1811121734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2104 PINEY BRANCH CIR APT 427
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21076-1837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-657-3036
Provider Business Mailing Address Fax Number:
888-460-0827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5457 TWIN KNOLLS RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-889-0727
Provider Business Practice Location Address Fax Number:
410-889-0729
Provider Enumeration Date:
05/06/2009

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: 225100000X , with the licence number:  22490 , 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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