Provider Demographics
NPI:1811475254
Name:OLATUNDE, KOLAWOLE RICHARD (HHA)
Entity type:Individual
Prefix:MR
First Name:KOLAWOLE
Middle Name:RICHARD
Last Name:OLATUNDE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:MR
Other - First Name:KOLAWOLE
Other - Middle Name:RICHARD
Other - Last Name:OLATUNDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HHA
Mailing Address - Street 1:11405 VILLA COURT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5702
Mailing Address - Country:US
Mailing Address - Phone:240-616-8410
Mailing Address - Fax:
Practice Address - Street 1:11405 VILLA COURT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:240-616-8410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13816374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide