Provider Demographics
NPI:1457698938
Name:OLAMIDE, KEMI B
Entity type:Individual
Prefix:MS
First Name:KEMI
Middle Name:B
Last Name:OLAMIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KEMISOLA
Other - Middle Name:BOSE
Other - Last Name:FALADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10169 NEW HAMPSHIRE AVE
Mailing Address - Street 2:#159
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1713
Mailing Address - Country:US
Mailing Address - Phone:240-421-1748
Mailing Address - Fax:301-439-6858
Practice Address - Street 1:10169 NEW HAMPSHIRE AVE
Practice Address - Street 2:#159
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1713
Practice Address - Country:US
Practice Address - Phone:240-421-1748
Practice Address - Fax:301-439-6858
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1234567Medicare Oscar/Certification
DC1234567Medicare PIN