Provider Demographics
NPI:1700254273
Name:OLADEINDE, FREDERICK
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:OLADEINDE
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 1:1055 TAYLOR AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8317
Mailing Address - Country:US
Mailing Address - Phone:410-321-6826
Mailing Address - Fax:410-321-6827
Practice Address - Street 1:1055 TAYLOR AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8317
Practice Address - Country:US
Practice Address - Phone:410-321-6826
Practice Address - Fax:410-321-6827
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH1584101YM0800X
MDR2448R374U00000X
MDNS1309006376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD068201200Medicaid
MD823702600Medicaid
MD411693300Medicaid
MD423729300Medicaid