Provider Demographics
NPI:1093318131
Name:DYNAMIC HEALTH SYSTEM
Entity Type:Organization
Organization Name:DYNAMIC HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:OLAYINKA
Authorized Official - Last Name:ANIBABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-708-2598
Mailing Address - Street 1:940 MADISON AVE STE L02-101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2113
Mailing Address - Country:US
Mailing Address - Phone:410-598-2219
Mailing Address - Fax:
Practice Address - Street 1:940 MADISON AVE STE 101102
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2113
Practice Address - Country:US
Practice Address - Phone:410-598-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder