Provider Demographics
NPI:1902272784
Name:OLOWE, SAMSON (PRESIDENT/CEO)
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:
Last Name:OLOWE
Suffix:
Gender:M
Credentials:PRESIDENT/CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 AVIS DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2283
Mailing Address - Country:US
Mailing Address - Phone:301-221-7553
Mailing Address - Fax:301-324-0897
Practice Address - Street 1:605 AVIS DRIVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-221-7553
Practice Address - Fax:301-324-0897
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP34789164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse