Provider Demographics
NPI:1578985354
Name:OGUNIBE, AYODEJI
Entity Type:Individual
Prefix:
First Name:AYODEJI
Middle Name:
Last Name:OGUNIBE
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 1:4802 STOCKTON LN
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1447
Mailing Address - Country:US
Mailing Address - Phone:240-899-2322
Mailing Address - Fax:301-306-5334
Practice Address - Street 1:4802 STOCKTON LN
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-1447
Practice Address - Country:US
Practice Address - Phone:240-899-2322
Practice Address - Fax:301-306-5334
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW14852420171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor