Provider Demographics
NPI:1568207330
Name:TAIWO, OLAWALE E
Entity type:Individual
Prefix:
First Name:OLAWALE
Middle Name:E
Last Name:TAIWO
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 1:42 JERVIS ST
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3531
Mailing Address - Country:US
Mailing Address - Phone:978-601-8165
Mailing Address - Fax:
Practice Address - Street 1:42 JERVIS ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3531
Practice Address - Country:US
Practice Address - Phone:978-601-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7480343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)