Provider Demographics
NPI:1316631070
Name:VIATONU, BANKOLE 0
Entity type:Individual
Prefix:
First Name:BANKOLE
Middle Name:0
Last Name:VIATONU
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 1:6495 NEW HAMPSHIRE AVE STE A303
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3245
Mailing Address - Country:US
Mailing Address - Phone:240-667-2357
Mailing Address - Fax:
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE STE A303
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3245
Practice Address - Country:US
Practice Address - Phone:240-667-2357
Practice Address - Fax:240-667-2743
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health