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General NPI Number Information
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NPI Number | 1689152100
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Entity Type | Individual
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Provider Name | CATHERINE ODUBANJO
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Gender | Female
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 4815 PRINCE GEORGES AVE STE 204
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City | BELTSVILLE
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State | MD
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Zip | 20705-1968
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Country | US
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Telephone | 301-399-6432
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Fax |
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Provider Business Mailing Address
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Address Line | 12329 PREAKNESS CIRCLE LN
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1227
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Country | US
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Telephone | 301-399-6432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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