Provider Demographics
NPI:1972932606
Name:POPOOLA, TAIWO
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:
Last Name:POPOOLA
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 1:6803 FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1531
Mailing Address - Country:US
Mailing Address - Phone:301-768-1711
Mailing Address - Fax:
Practice Address - Street 1:6803 FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1531
Practice Address - Country:US
Practice Address - Phone:301-768-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9162374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide