Provider Demographics
NPI:1235962846
Name:AWOLOPE, TAIWO ABIOLA I
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:ABIOLA
Last Name:AWOLOPE
Suffix:I
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 1:6911 GLEN RIDGE CIR APT A1
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5623
Mailing Address - Country:US
Mailing Address - Phone:301-756-6683
Mailing Address - Fax:
Practice Address - Street 1:6911 GLEN RIDGE CIR APT A1
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5623
Practice Address - Country:US
Practice Address - Phone:301-756-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator