Provider Demographics
NPI:1689878753
Name:OGUNDEPO, ADEWOLE ALABI (LPTA)
Entity Type:Individual
Prefix:
First Name:ADEWOLE
Middle Name:ALABI
Last Name:OGUNDEPO
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9747 GOOD LUCK RD
Mailing Address - Street 2:APT 11
Mailing Address - City:SEABROOK
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3323
Mailing Address - Country:US
Mailing Address - Phone:301-996-6289
Mailing Address - Fax:
Practice Address - Street 1:831 UNIVERSITY BLVD E
Practice Address - Street 2:#14
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2916
Practice Address - Country:US
Practice Address - Phone:301-445-3192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLPTA1998225200000X
MDR153729363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant