Healthcare Provider Details

I. General information

NPI: 1629068333
Provider Name (Legal Business Name): WAYNE J OLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE NW SUITE 7-420
WASHINGTON DC
20037
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW SUITE 7-420
WASHINGTON DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2750
  • Fax: 202-741-2742
Mailing address:
  • Phone: 202-741-2750
  • Fax: 202-741-2742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0045161
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD45161
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberD0045161
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD20011
License Number StateDC
# 5
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD20011
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: