Healthcare Provider Details

I. General information

NPI: 1770812315
Provider Name (Legal Business Name): MED CHAMPIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 RHODE ISLAND AVE NE APT 304
WASHINGTON DC
20002-6836
US

IV. Provider business mailing address

1229 WINDMILL LN
SILVER SPRING MD
20905-6055
US

V. Phone/Fax

Practice location:
  • Phone: 301-427-4630
  • Fax: 301-438-3374
Mailing address:
  • Phone: 301-437-4630
  • Fax: 301-438-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. FEMI K. OYEDELE
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 301-437-4630