Healthcare Provider Details

I. General information

NPI: 1639576358
Provider Name (Legal Business Name): ALPHA POINT MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD SUITE M8B
BERWYN HEIGHTS MD
20740-2354
US

IV. Provider business mailing address

PO BOX 507
FULTON MD
20759-0507
US

V. Phone/Fax

Practice location:
  • Phone: 301-313-9013
  • Fax: 301-313-9015
Mailing address:
  • Phone: 301-313-9013
  • Fax: 301-313-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR118268
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD45217
License Number StateMD

VIII. Authorized Official

Name: DR. ADEBOWALE I AJAYI
Title or Position: PRESIDENT
Credential: MD
Phone: 301-313-9013