MEDICARE: MISS LATEEFAT OMOLARA FAGBENRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	NA00809491	MD
2	374U00000X	Home Health Aide	HHA11333	DC

General Provider Information

NPI Number	:	1346624939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LATEEFAT OMOLARA FAGBENRO

Provider Business Mailing Address
First Line	:	3318 DODGE PARK RD APT 101
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-2114
Country	:	US
Telephone Number	:	240-413-1823
Fax Number	:

Provider Business Practice Location Address
First Line	:	3318 DODGE PARK RD APT 101
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-2114
Country	:	US
Telephone Number	:	240-413-1823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2015
Last Update Date	:	03/14/2018

Similar Medicare Providers

1720566383 — LAWRENCE UGBAR MBEH
Practice Location Address:

3318 DODGE PARK RD APT 304
HYATTSVILLE, MD
20785-2114

Practice Phone: 240-714-7959
Practice Fax:

1295397891 — SOLANGE AFANTENAH
Practice Location Address:

3318 DODGE PARK RD APT 104
HYATTSVILLE, MD
20785-2114

Practice Phone: 301-851-9129
Practice Fax:

1932926938 — MODESTA NGEBI
Practice Location Address:

3318 DODGE PARK RD APT 201
HYATTSVILLE, MD
20785-2114

Practice Phone: 240-564-7386
Practice Fax:

1760295414 — ALFRED MFOMO TAMBE
Practice Location Address:

3318 DODGE PARK RD
HYATTSVILLE, MD
20785-2114

Practice Phone: 240-886-5012
Practice Fax:

1649154238 — NUELA TIFU KEM
Practice Location Address:

3318 DODGE PARK RD APT 201
HYATTSVILLE, MD
20785-2114

Practice Phone: 240-413-6909
Practice Fax:

1548259757 — THE KIDZ NP, INC.
Practice Location Address:

8700 CENTRAL AVE STE 302
LANDOVER, MD
20785-4853

Practice Phone: 301-333-0083
Practice Fax: 301-333-0442

Directions to “ MISS LATEEFAT OMOLARA FAGBENRO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.