Provider Demographics
NPI:1396170775
Name:HAKIM O. OGUNSANYA
Entity type:Organization
Organization Name:HAKIM O. OGUNSANYA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP-PMH- FAMILY
Authorized Official - Prefix:MR
Authorized Official - First Name:HAKIM
Authorized Official - Middle Name:O
Authorized Official - Last Name:OGUNSANYA
Authorized Official - Suffix:IV
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-906-7349
Mailing Address - Street 1:8225 LONDONDERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5626
Mailing Address - Country:US
Mailing Address - Phone:301-362-1117
Mailing Address - Fax:
Practice Address - Street 1:8225 LONDONDERRY CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5626
Practice Address - Country:US
Practice Address - Phone:301-362-1117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184091261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health