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General NPI Number Information
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NPI Number | 1356149942
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Entity Type | Organization
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Legal Business Name | CENTRAL LAKES MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 7923 HONEYGO BLVD 217
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City | NOTTINGHAM
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State | MD
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Zip | 21236
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Country | US
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Telephone | 443-470-2698
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Fax | 883-973-3543
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Provider Business Mailing Address
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Address Line | 7923 HONEYGO BLVD 217
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City | NOTTINGHAM
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State | MD
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Zip | 21236
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Country | US
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Telephone | 443-470-2698
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Fax | 883-973-3543
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Authorized Official
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Title or Position | PHYSICIAN/ OWNER
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Name | DR. IRENE L ATIENO OLONDE
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Credential | MD
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Telephone | 443-470-2698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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