Healthcare Provider Details

I. General information

NPI: 1306481429
Provider Name (Legal Business Name): OLOUWAKEMI DELANO BIAOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 OLD ANNAPOLIS RD STE 100
COLUMBIA MD
21045-2146
US

IV. Provider business mailing address

9338 SILVER CHARM DR
RANDALLSTOWN MD
21133-4610
US

V. Phone/Fax

Practice location:
  • Phone: 703-506-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: