Provider Demographics
NPI:1710227087
Name:OMOLE, JAMES B
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:OMOLE
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 1:5308 4TH ST NW APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3172
Mailing Address - Country:US
Mailing Address - Phone:240-755-3976
Mailing Address - Fax:
Practice Address - Street 1:5308 4TH ST NW APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3172
Practice Address - Country:US
Practice Address - Phone:240-755-3976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide