MEDICARE: AYODEJI OGUNIBE

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	171W00000X	Contractor	W14852420	MD

General Provider Information

NPI Number	:	1578985354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYODEJI OGUNIBE

Provider Business Mailing Address
First Line	:	4802 STOCKTON LN
Second Line	:
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-1447
Country	:	US
Telephone Number	:	240-899-2322
Fax Number	:	301-306-5334

Provider Business Practice Location Address
First Line	:	4802 STOCKTON LN
Second Line	:
City	:	LANDOVER HILLS
State	:	MD
Zip	:	20784-1447
Country	:	US
Telephone Number	:	240-899-2322
Fax Number	:	301-306-5334

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

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	01/13/2014

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