Provider Demographics
NPI:1134993579
Name:GERIPALMD
Entity type:Organization
Organization Name:GERIPALMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE-GERIATRICS
Authorized Official - Prefix:
Authorized Official - First Name:TOLULOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMUYIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-437-4362
Mailing Address - Street 1:3636 S SHERWOOD FOREST BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5216
Mailing Address - Country:US
Mailing Address - Phone:240-437-4362
Mailing Address - Fax:
Practice Address - Street 1:3636 S SHERWOOD FOREST BLVD STE 650
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5216
Practice Address - Country:US
Practice Address - Phone:240-437-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty