Healthcare Provider Details

I. General information

NPI: 1497095202
Provider Name (Legal Business Name): CHRISTOPHER ADEOYE OGUNREMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 AUTOMOTIVE BLVD
ELKTON MD
21921-6374
US

IV. Provider business mailing address

108 AUTOMOTIVE BLVD
ELKTON MD
21921-6374
US

V. Phone/Fax

Practice location:
  • Phone: 302-757-4765
  • Fax:
Mailing address:
  • Phone: 302-757-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: