Provider Demographics
NPI:1609410083
Name:ABIMBOLA-PETERS, FREDRICK OLAPADE
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:OLAPADE
Last Name:ABIMBOLA-PETERS
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 1:11694 S LAUREL DR APT 4B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3039
Mailing Address - Country:US
Mailing Address - Phone:240-264-0882
Mailing Address - Fax:
Practice Address - Street 1:11694 S LAUREL DR APT 4B
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3039
Practice Address - Country:US
Practice Address - Phone:240-264-0882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14847374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide