Healthcare Provider Details

I. General information

NPI: 1609232867
Provider Name (Legal Business Name): ABIADE OGUNSOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 EDMONSTON RD STE D
GREENBELT MD
20770-4043
US

IV. Provider business mailing address

8955 EDMONSTON RD STE D
GREENBELT MD
20770-4043
US

V. Phone/Fax

Practice location:
  • Phone: 301-882-8700
  • Fax: 301-882-8820
Mailing address:
  • Phone: 301-882-8700
  • Fax: 301-882-8820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00997559
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX6261
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL005908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: