Healthcare Provider Details

I. General information

NPI: 1821167149
Provider Name (Legal Business Name): AKINLAWON OLUGBENGA AYENI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MERCANTILE LN STE 180
LARGO MD
20774-5369
US

IV. Provider business mailing address

7137 FOX HARBOR WAY
ELKRIDGE MD
21075-6570
US

V. Phone/Fax

Practice location:
  • Phone: 301-925-7022
  • Fax: 301-925-4463
Mailing address:
  • Phone: 410-379-8380
  • Fax: 301-925-4463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number26699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: