Healthcare Provider Details

I. General information

NPI: 1932092996
Provider Name (Legal Business Name): ROTIMI ABEL OGUNSHOLA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7090 SAMUEL MORSE DR STE 100
COLUMBIA MD
21046-3444
US

IV. Provider business mailing address

12512 STURDEE DR
UPPER MARLBORO MD
20772-4222
US

V. Phone/Fax

Practice location:
  • Phone: 202-705-4802
  • Fax:
Mailing address:
  • Phone: 202-705-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-439062
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: