Provider Demographics
NPI:1508315474
Name:OGUNRINDE, TOPE
Entity Type:Individual
Prefix:
First Name:TOPE
Middle Name:
Last Name:OGUNRINDE
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 1:3553 55TH AVENUE APT6 HYATTIVILLES
Mailing Address - Street 2:
Mailing Address - City:HYATTIVILLES
Mailing Address - State:MD
Mailing Address - Zip Code:20784
Mailing Address - Country:US
Mailing Address - Phone:240-495-9584
Mailing Address - Fax:
Practice Address - Street 1:3553 55TH AVENUE APT6 HYATTIVILLES
Practice Address - Street 2:
Practice Address - City:HYATTIVILLES
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:240-495-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12197172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker