Provider Demographics
NPI:1255731568
Name:OGUNLEYE, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:OGUNLEYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 DODGE PARK RD
Mailing Address - Street 2:APT 101
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3424 DODGE PARK RD
Practice Address - Street 2:APT 101
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2049
Practice Address - Country:US
Practice Address - Phone:240-467-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide