Healthcare Provider Details

I. General information

NPI: 1245087618
Provider Name (Legal Business Name): GLORY O OGUNDOJU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/03/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PENNYSYLVANIA AVENUE SE
WASHINGTON DC
20004
US

IV. Provider business mailing address

913 POSTWICK PL
BOWIE MD
20716-1917
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-1512
  • Fax:
Mailing address:
  • Phone: 240-486-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: