Most Relevant Information
Provider Data
| NPI Number: | 1003669763 |
| Provider Name: | OLAITAN KEJI BAMGBALA |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/10/2024 |
| Last Updated: | 04/10/2024 |
Provider Practice Location
10081 CAMPUS WAY S
UPPER MARLBORO
MD
207742103
Practice Location Phone/Fax
| Phone: | 4439792438 |
| Fax: |
Provider Mailing Location
10081 CAMPUS WAY S
UPPER MARLBORO
MD
207742103
Provider Mailing Phone/Fax
| Phone: | 4439792438 |
| Fax: |