Provider Demographics
NPI:1427646504
Name:AKINWALE, AKINJIDE ABAS
Entity type:Individual
Prefix:
First Name:AKINJIDE
Middle Name:ABAS
Last Name:AKINWALE
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 1:630 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5954
Mailing Address - Country:US
Mailing Address - Phone:240-817-6036
Mailing Address - Fax:
Practice Address - Street 1:630 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5954
Practice Address - Country:US
Practice Address - Phone:240-817-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15506251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA254038029362OtherMVA