Basic Information
| Provider Information | |||||||||
| NPI: | 1518902014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENIOLA | ||||||||
| FirstName: | RAZAAK | ||||||||
| MiddleName: | ALABI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10026 OLD OCEAN CITY BLVD | ||||||||
| Address2: | BUILDING ONE | ||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106419109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9733 HEALTHWAY DR | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106419109 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 04/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D50826 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | D0050826 | MD | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101055107 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | D0050826 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00329885 | 01 | RAILROAD MEDICARE | OTHER | 956961800 | 05 | MD | MEDICAID |