Healthcare Provider Details

I. General information

NPI: 1902394281
Provider Name (Legal Business Name): MR. TAIWO O DARAMOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 KENILWORTH AVE NE
WASHINGTON DC
20019-2010
US

IV. Provider business mailing address

872 WARLEY DR
HYATTSVILLE MD
20785-5925
US

V. Phone/Fax

Practice location:
  • Phone: 202-588-8036
  • Fax: 202-588-8038
Mailing address:
  • Phone: 240-334-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13639
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: