Provider Demographics
NPI:1962164574
Name:GANI CARE AMBULATORY CLINIC
Entity type:Organization
Organization Name:GANI CARE AMBULATORY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GANIYU
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADEWALE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-557-2913
Mailing Address - Street 1:9500 ANNAPOLIS RD STE 8
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2060
Mailing Address - Country:US
Mailing Address - Phone:240-582-7866
Mailing Address - Fax:
Practice Address - Street 1:9500 ANNAPOLIS RD STE 8
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2060
Practice Address - Country:US
Practice Address - Phone:240-582-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service