Healthcare Provider Details

I. General information

NPI: 1649367632
Provider Name (Legal Business Name): BABATUNDE MUSTAPHA AJANI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 W BELVEDERE AVE LEVINDALE HEBREW GERIATRIC CENTER ATTN: MEDICAL OFFICE
BALTIMORE MD
21215-5267
US

IV. Provider business mailing address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-2246
  • Fax:
Mailing address:
  • Phone: 301-552-8130
  • Fax: 301-552-8135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0064533
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD64533
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberD64533
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: