Provider Demographics
NPI:1447701396
Name:OASIS HEALTH VENTURES
Entity type:Organization
Organization Name:OASIS HEALTH VENTURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAWALE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-272-2614
Mailing Address - Street 1:2500 N. ROLLING ROAD (SUITE 100)
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:443-272-2614
Mailing Address - Fax:443-272-2664
Practice Address - Street 1:2500 N. ROLLING ROAD (SUITE 100)
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244
Practice Address - Country:US
Practice Address - Phone:443-272-2614
Practice Address - Fax:443-272-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-16
Last Update Date:2020-03-29
Deactivation Date:2020-03-15
Deactivation Code:
Reactivation Date:2020-03-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD500166800Medicaid
MDMH 260OtherLICENSE