Provider Demographics
NPI:1407261704
Name:OLALEYE, CHARLES AYOWOLE
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:AYOWOLE
Last Name:OLALEYE
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 1:9209 TURNBULL RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3307
Mailing Address - Country:US
Mailing Address - Phone:443-278-3817
Mailing Address - Fax:
Practice Address - Street 1:2101 E JEFFERSON ST STE 6WPPQA
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4908
Practice Address - Country:US
Practice Address - Phone:301-816-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD045617207Q00000X
VA0101263114207Q00000X
MDD83402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty