Provider Demographics
NPI:1609131911
Name:SAVAGE, GLADYS OMOTOLA
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:OMOTOLA
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9789 GOODLUCK RD
Mailing Address - Street 2:10
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:301-996-0435
Mailing Address - Fax:
Practice Address - Street 1:9789 GOODLUCK RD
Practice Address - Street 2:10
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-996-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide