Healthcare Provider Details

I. General information

NPI: 1447689591
Provider Name (Legal Business Name): RASHEED GBADEGESIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 GLEN WILLOW DR APT 4
SEAT PLEASANT MD
20743-1561
US

IV. Provider business mailing address

1103 GLEN WILLOW DR APT 4
SEAT PLEASANT MD
20743-1561
US

V. Phone/Fax

Practice location:
  • Phone: 240-694-7734
  • Fax:
Mailing address:
  • Phone: 240-694-7734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: