Provider Demographics
NPI:1760342166
Name:RADLAN HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:RADLAN HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOLARA
Authorized Official - Middle Name:OMOLOLA
Authorized Official - Last Name:AMOSU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:518-312-4705
Mailing Address - Street 1:11502 IAGER BLVD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2653
Mailing Address - Country:US
Mailing Address - Phone:240-441-9959
Mailing Address - Fax:
Practice Address - Street 1:11502 IAGER BLVD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2653
Practice Address - Country:US
Practice Address - Phone:240-441-9959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-17
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty