MEDICARE: OLUWOLE ODUALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1376363259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWOLE ODUALA

Provider Business Mailing Address
First Line	:	7555 MAIDEN HEAD DR
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1925
Country	:	US
Telephone Number	:	443-572-9756
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 50TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5307
Country	:	US
Telephone Number	:	202-883-1047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/23/2024

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Directions to “ OLUWOLE ODUALA ” Practice Location

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