Provider Demographics
NPI:1003552159
Name:GT HEALTHCARE INC
Entity Type:Organization
Organization Name:GT HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWATOSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANIMO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:202-246-3013
Mailing Address - Street 1:10515 THEODORE GREEN BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3044
Mailing Address - Country:US
Mailing Address - Phone:202-246-3013
Mailing Address - Fax:202-246-3013
Practice Address - Street 1:10515 THEODORE GREEN BLVD STE 212
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3044
Practice Address - Country:US
Practice Address - Phone:202-246-3013
Practice Address - Fax:202-246-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty