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General NPI Number Information
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NPI Number | 1073233912
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Entity Type | Organization
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Legal Business Name | OPTIMUM PRIMARY CARE SERVICES LLC
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 240-997-8976
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44722
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City | FORT WASHINGTON
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State | MD
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Zip | 20749-4722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | ADEDIWURA AJADI
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Credential | CRNP
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Telephone | 240-997-8976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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