Provider Demographics
NPI:1871354456
Name:OJOEMELAM, OKEOSISI
Entity type:Individual
Prefix:
First Name:OKEOSISI
Middle Name:
Last Name:OJOEMELAM
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 1:4313 QUANDERS PROMISE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4694
Mailing Address - Country:US
Mailing Address - Phone:240-498-4543
Mailing Address - Fax:
Practice Address - Street 1:4313 QUANDERS PROMISE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4694
Practice Address - Country:US
Practice Address - Phone:240-498-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-02185251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health