Provider Demographics
NPI:1720623242
Name:ASSURED ACCESS MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:ASSURED ACCESS MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUREMI
Authorized Official - Middle Name:TUNDE
Authorized Official - Last Name:ILUPEJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-674-9319
Mailing Address - Street 1:7221 HANOVER PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2022
Mailing Address - Country:US
Mailing Address - Phone:301-674-9319
Mailing Address - Fax:301-439-0968
Practice Address - Street 1:7221 HANOVER PKWY STE C
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2022
Practice Address - Country:US
Practice Address - Phone:301-674-9319
Practice Address - Fax:301-439-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD193328100Medicaid