Provider Demographics
NPI:1669067005
Name:OLUBODE, ALABA A
Entity type:Individual
Prefix:
First Name:ALABA A
Middle Name:
Last Name:OLUBODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 CONGRESS PL
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4729
Mailing Address - Country:US
Mailing Address - Phone:240-302-4925
Mailing Address - Fax:
Practice Address - Street 1:9019 CONGRESS PL
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4729
Practice Address - Country:US
Practice Address - Phone:240-302-4925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide