Provider Demographics
NPI:1669284063
Name:BANDOLO OLOUGOU, FELICIEN
Entity type:Individual
Prefix:
First Name:FELICIEN
Middle Name:
Last Name:BANDOLO OLOUGOU
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 1:7135 BRITENS WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-6264
Mailing Address - Country:US
Mailing Address - Phone:614-905-5445
Mailing Address - Fax:
Practice Address - Street 1:7135 BRITENS WAY
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-6264
Practice Address - Country:US
Practice Address - Phone:614-905-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator