Provider Demographics
NPI:1902394281
Name:DARAMOLA, TAIWO O
Entity Type:Individual
Prefix:MR
First Name:TAIWO
Middle Name:O
Last Name:DARAMOLA
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 1:872 WARLEY DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5925
Mailing Address - Country:US
Mailing Address - Phone:240-334-8158
Mailing Address - Fax:
Practice Address - Street 1:1615 KENILWORTH AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2010
Practice Address - Country:US
Practice Address - Phone:202-588-8036
Practice Address - Fax:202-588-8038
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13639374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13639OtherBOARD OF NURSING