Healthcare Provider Details

I. General information

NPI: 1760904601
Provider Name (Legal Business Name): OLUWATOSIN GBOLADE OMOTOYE-AKINWOLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 DODGE PARK RD APT 102
LANDOVER MD
20785-2013
US

IV. Provider business mailing address

3405 DODGE PARK RD APT 102
LANDOVER MD
20785-2013
US

V. Phone/Fax

Practice location:
  • Phone: 347-238-9367
  • Fax:
Mailing address:
  • Phone: 347-238-9367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberHH12809
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: