Provider Demographics
NPI:1578906897
Name:JIMOH, BABATUNDE
Entity type:Individual
Prefix:MR
First Name:BABATUNDE
Middle Name:
Last Name:JIMOH
Suffix:
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 1:6490 LANDOVER RD STE D3
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1443
Mailing Address - Country:US
Mailing Address - Phone:240-413-4131
Mailing Address - Fax:
Practice Address - Street 1:6490 LANDOVER RD STE D3
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:240-413-4131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2024-10-31
Deactivation Date:2024-09-27
Deactivation Code:
Reactivation Date:2024-10-31
Provider Licenses
StateLicense IDTaxonomies
DC31234164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse