Provider Demographics
NPI:1396419917
Name:AGBOOLA, OLOLADE
Entity Type:Individual
Prefix:
First Name:OLOLADE
Middle Name:
Last Name:AGBOOLA
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 1:209 COLTON ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1503
Mailing Address - Country:US
Mailing Address - Phone:240-516-4921
Mailing Address - Fax:
Practice Address - Street 1:209 COLTON ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1503
Practice Address - Country:US
Practice Address - Phone:240-516-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide