Provider Demographics
NPI:1487917860
Name:SAMUEL, ADEITE MOJIBOLA
Entity type:Individual
Prefix:
First Name:ADEITE
Middle Name:MOJIBOLA
Last Name:SAMUEL
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 1:111 N ROCK GLEN RD APT H
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3187
Mailing Address - Country:US
Mailing Address - Phone:202-717-6753
Mailing Address - Fax:
Practice Address - Street 1:5626 WHITFIELD CHAPEL RD
Practice Address - Street 2:APT 201
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:202-717-6753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide