Provider Demographics
NPI:1487271011
Name:OLATIDOYE, MOBOLAJI
Entity type:Individual
Prefix:
First Name:MOBOLAJI
Middle Name:
Last Name:OLATIDOYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 BIG BUCK DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2067
Mailing Address - Country:US
Mailing Address - Phone:443-838-2189
Mailing Address - Fax:
Practice Address - Street 1:7705 BIG BUCK DR
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2067
Practice Address - Country:US
Practice Address - Phone:410-234-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195010163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health