Provider Demographics
NPI:1003432097
Name:TRIUMPH PEDIATRIC CENTER
Entity Type:Organization
Organization Name:TRIUMPH PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OMOLOLU
Authorized Official - Middle Name:OLUWATOSIN
Authorized Official - Last Name:MAJEKODUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:240-336-4976
Mailing Address - Street 1:1710 W VIRGINIA AVE NE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2338
Mailing Address - Country:US
Mailing Address - Phone:202-739-1861
Mailing Address - Fax:
Practice Address - Street 1:4900 MASSACHUSETTS AVE NW # 340
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4358
Practice Address - Country:US
Practice Address - Phone:240-336-4976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech