Healthcare Provider Details

I. General information

NPI: 1831681717
Provider Name (Legal Business Name): KAFAYAT OLABISI BELLO-OGUNDIPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD COURT RD
RANDALLSTOWN MD
21133
US

IV. Provider business mailing address

1 MERIDIAN LN APT 303
OWINGS MILLS MD
21117-5385
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-2200
  • Fax:
Mailing address:
  • Phone: 571-232-9182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR234696
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: