MEDICARE: ANUOLUWAPO ENITAN ADEGBESAN

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	374U00000X	Home Health Aide		DC
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1629339486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANUOLUWAPO ENITAN ADEGBESAN

Provider Business Mailing Address
First Line	:	2322 BRIGHTSEAT RD APT 7
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-3558
Country	:	US
Telephone Number	:	202-423-0153
Fax Number	:	202-722-7785

Provider Business Practice Location Address
First Line	:	114 50TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-5307
Country	:	US
Telephone Number	:	202-840-9776
Fax Number	:

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

Provider Enumeration Date	:	06/07/2012
Last Update Date	:	06/05/2020

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