Provider Demographics
NPI:1447908025
Name:MAGNUM HEALTHCARE
Entity type:Organization
Organization Name:MAGNUM HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NURSING PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:DARAMOLA
Authorized Official - Middle Name:AKINDELE
Authorized Official - Last Name:AYOADE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:301-642-2029
Mailing Address - Street 1:9213 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1894
Mailing Address - Country:US
Mailing Address - Phone:301-642-2029
Mailing Address - Fax:
Practice Address - Street 1:10770 COLUMBIA PIKE STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4439
Practice Address - Country:US
Practice Address - Phone:240-633-0853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty