Healthcare Provider Details

I. General information

NPI: 1639045842
Provider Name (Legal Business Name): FAROUK ALADE GBADAMOSI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 15TH ST NE
WASHINGTON DC
20002-4508
US

IV. Provider business mailing address

12230 LONGFIELD DR APT 440
SILVER SPRING MD
20904-2154
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-8500
  • Fax:
Mailing address:
  • Phone: 443-527-9212
  • Fax: 443-527-9212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500024401
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: