Provider Demographics
NPI:1417566944
Name:WALE - AREMU, OLAWALE
Entity Type:Individual
Prefix:DR
First Name:OLAWALE
Middle Name:
Last Name:WALE - AREMU
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 1:8963 CENTERWAY RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-1802
Mailing Address - Country:US
Mailing Address - Phone:240-645-5344
Mailing Address - Fax:
Practice Address - Street 1:8963 CENTERWAY RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-1802
Practice Address - Country:US
Practice Address - Phone:240-645-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily