Healthcare Provider Details

I. General information

NPI: 1194432047
Provider Name (Legal Business Name): OLUBUMI FABIYI TEMIDAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ONAOLA FABIYI TEMIDAYO

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 CARYHURST DR
FORT WASHINGTON MD
20744-3113
US

IV. Provider business mailing address

6202 CARYHURST DR
FORT WASHINGTON MD
20744-3113
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-2120
  • Fax:
Mailing address:
  • Phone: 301-728-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: