MEDICARE: OMOTUNDE O AJIBOLA

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
2	171M00000X	Case Manager/Care Coordinator		DC

General Provider Information

NPI Number	:	1831305671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMOTUNDE O AJIBOLA

Provider Business Mailing Address
First Line	:	9913 GREENBELT RD APT 202
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-2244
Country	:	US
Telephone Number	:	240-838-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 24TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2126
Country	:	US
Telephone Number	:	202-832-8340
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/25/2023

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Directions to “ OMOTUNDE O AJIBOLA ” Practice Location

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