Basic Information
| Provider Information | |||||||||
| NPI: | 1447908025 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGNUM HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9213 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207231894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016422029 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9213 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207231894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016422029 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2022 | ||||||||
| LastUpdateDate: | 03/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | AYOADE | ||||||||
| AuthorizedOfficialFirstName: | DARAMOLA | ||||||||
| AuthorizedOfficialMiddleName: | AKINDELE | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR OF NURSING PRACTICE | ||||||||
| AuthorizedOfficialTelephone: | 3016422029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PMHNP | ||||||||
| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.