Healthcare Provider Details

I. General information

NPI: 1447908025
Provider Name (Legal Business Name): MAGNUM HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

IV. Provider business mailing address

9213 FULTON AVE
LAUREL MD
20723-1894
US

V. Phone/Fax

Practice location:
  • Phone: 240-633-0853
  • Fax:
Mailing address:
  • Phone: 301-642-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DARAMOLA AKINDELE AYOADE
Title or Position: DOCTOR OF NURSING PRACTICE
Credential: PMHNP
Phone: 301-642-2029