Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 26699 | GA |
NPI | 1821167149 |
---|---|
Provider Name | Mr. Akinlawon Olugbenga Ayeni |
First Address | Elkridge, MD 21075-6570 |
Second Address | Largo, MD 20774-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 28/12/2021 |