Provider Demographics
NPI:1609232867
Name:OGUNSOLA, ABIADE
Entity Type:Individual
Prefix:
First Name:ABIADE
Middle Name:
Last Name:OGUNSOLA
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 1:8955 EDMONSTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4043
Mailing Address - Country:US
Mailing Address - Phone:301-882-8700
Mailing Address - Fax:301-882-8820
Practice Address - Street 1:8955 EDMONSTON RD STE D
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4043
Practice Address - Country:US
Practice Address - Phone:301-882-8700
Practice Address - Fax:301-882-8820
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005908133V00000X
NJ00997559133V00000X
MDDX6261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered