Provider Demographics
NPI:1669074431
Name:DYNAMIC HEALTH SYSTEM INC
Entity type:Organization
Organization Name:DYNAMIC HEALTH SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:OLAYINKA
Authorized Official - Last Name:ANIBABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-708-2598
Mailing Address - Street 1:940 MADISON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2113
Mailing Address - Country:US
Mailing Address - Phone:410-598-2219
Mailing Address - Fax:
Practice Address - Street 1:940 MADISON AVE STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2113
Practice Address - Country:US
Practice Address - Phone:410-598-2219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1184155749Medicaid