=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770953846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMIT MEDICAL & CONSULTING GROUP INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2015
-----------------------------------------------------
Last Update Date | 10/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 WESTPARK DR STE 140
-----------------------------------------------------
City | TYSONS CORNER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22102-3197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-488-1274
-----------------------------------------------------
Fax | 703-404-2703
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8000 WESTPARK DR STE 140
-----------------------------------------------------
City | TYSONS CORNER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22102-3197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-488-1274
-----------------------------------------------------
Fax | 703-404-2703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OFFICER
-----------------------------------------------------
Name | DR. TEMITOPE OYEGBILE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 571-488-1274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0402X
-----------------------------------------------------
Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
-----------------------------------------------------
License Number | 0101250149
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 0101256049
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084S0012X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 0101250149
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 0101256049
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------