Healthcare Provider Details

I. General information

NPI: 1386256469
Provider Name (Legal Business Name): LAKIN OGUNDIRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5438 85TH AVE APT 201
NEW CARROLLTON MD
20784-3119
US

IV. Provider business mailing address

5438 85TH AVE APT 201
NEW CARROLLTON MD
20784-3119
US

V. Phone/Fax

Practice location:
  • Phone: 240-347-5396
  • Fax:
Mailing address:
  • Phone: 240-347-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: