Healthcare Provider Details

I. General information

NPI: 1366733313
Provider Name (Legal Business Name): EQUIP HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 LINDEN AVE STE 1
HALETHORPE MD
21227-2407
US

IV. Provider business mailing address

1335 LINDEN AVE STE 1
HALETHORPE MD
21227-2407
US

V. Phone/Fax

Practice location:
  • Phone: 410-737-8780
  • Fax:
Mailing address:
  • Phone: 410-737-8780
  • Fax: 410-737-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD0057747
License Number StateMD

VIII. Authorized Official

Name: DR. AKINLAWON OLUGBENGA AYENI
Title or Position: OWNER
Credential: MD
Phone: 703-408-8328