Provider Demographics
NPI:1497417273
Name:EROSUN MEDICAL CARE
Entity Type:Organization
Organization Name:EROSUN MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:410-296-4641
Mailing Address - Street 1:1045 TAYLOR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8357
Mailing Address - Country:US
Mailing Address - Phone:410-296-4641
Mailing Address - Fax:
Practice Address - Street 1:1045 TAYLOR AVE STE 101
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8357
Practice Address - Country:US
Practice Address - Phone:410-296-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EROSUN BEHAVIORAL HEALTH SERVICES INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service