Provider Demographics
NPI:1982328076
Name:AJAYI-OBE, AKINGBOYEGA AKINYEMI
Entity Type:Individual
Prefix:
First Name:AKINGBOYEGA
Middle Name:AKINYEMI
Last Name:AJAYI-OBE
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 1:6555 TYSON PL
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5808
Mailing Address - Country:US
Mailing Address - Phone:240-491-6036
Mailing Address - Fax:
Practice Address - Street 1:6555 TYSON PL
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5808
Practice Address - Country:US
Practice Address - Phone:240-491-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver