Provider Demographics
NPI:1326498049
Name:OGBE, OLAIDE
Entity Type:Individual
Prefix:
First Name:OLAIDE
Middle Name:
Last Name:OGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3426 55TH AVE
Mailing Address - Street 2:#402
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1034
Mailing Address - Country:US
Mailing Address - Phone:240-779-1437
Mailing Address - Fax:
Practice Address - Street 1:3426 55TH AVE
Practice Address - Street 2:#402
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1034
Practice Address - Country:US
Practice Address - Phone:240-779-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12057374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDO210660660898OtherID