Provider Demographics
NPI:1295910891
Name:LAKEWOOD HEALTHCARE CENTER
Entity type:Organization
Organization Name:LAKEWOOD HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-925-7022
Mailing Address - Street 1:1400 MERCANTILE LN STE 180
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5369
Mailing Address - Country:US
Mailing Address - Phone:301-925-7002
Mailing Address - Fax:301-925-4463
Practice Address - Street 1:1400 MERCANTILE LN STE 180
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5369
Practice Address - Country:US
Practice Address - Phone:301-925-7002
Practice Address - Fax:301-925-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty