Healthcare Provider Details

I. General information

NPI: 1053181644
Provider Name (Legal Business Name): OASIS HEALTH VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N ROLLING RD
WINDSOR MILL MD
21244-1990
US

IV. Provider business mailing address

2500 N ROLLING RD
WINDSOR MILL MD
21244-1990
US

V. Phone/Fax

Practice location:
  • Phone: 443-272-2614
  • Fax: 443-272-2664
Mailing address:
  • Phone: 443-272-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: OLUFEMI OLAWALE
Title or Position: NP
Credential:
Phone: 443-272-2614