MEDICARE: OLUSEGUN DANIEL BADEJO

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1831057207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUSEGUN DANIEL BADEJO

Provider Business Mailing Address
First Line	:	10902 WATER PORT CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2926
Country	:	US
Telephone Number	:	240-486-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	10902 WATER PORT CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2926
Country	:	US
Telephone Number	:	240-486-9764
Fax Number	:

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

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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