Provider Demographics
NPI:1407550718
Name:ACE CLINIC
Entity Type:Organization
Organization Name:ACE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OLUBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUDARA-FADARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-4465
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0837
Mailing Address - Country:US
Mailing Address - Phone:301-220-4465
Mailing Address - Fax:
Practice Address - Street 1:7347 HANOVER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3629
Practice Address - Country:US
Practice Address - Phone:301-220-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACE URGENT CARE AND CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-29
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care