Provider Demographics
NPI:1790562734
Name:ALAO, AKINWUMI
Entity Type:Individual
Prefix:
First Name:AKINWUMI
Middle Name:
Last Name:ALAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AKINWUMI
Other - Middle Name:
Other - Last Name:ALAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FOUNTAIN HEALTH CARE
Mailing Address - Street 1:117 SHININGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1771
Mailing Address - Country:US
Mailing Address - Phone:301-256-6624
Mailing Address - Fax:
Practice Address - Street 1:117 SHININGFIELD CT
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1771
Practice Address - Country:US
Practice Address - Phone:301-256-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01714251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health