Provider Demographics
NPI:1114531464
Name:OYEBADE, ADENIRAN
Entity Type:Individual
Prefix:
First Name:ADENIRAN
Middle Name:
Last Name:OYEBADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18562 SPLIT ROCK LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2113
Mailing Address - Country:US
Mailing Address - Phone:301-835-3867
Mailing Address - Fax:
Practice Address - Street 1:18562 SPLIT ROCK LN
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2113
Practice Address - Country:US
Practice Address - Phone:301-835-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHCS800302374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty