Provider Demographics
NPI:1366733313
Name:EQUIP HEALTH SERVICES
Entity type:Organization
Organization Name:EQUIP HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINLAWON
Authorized Official - Middle Name:OLUGBENGA
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-408-8328
Mailing Address - Street 1:1335 LINDEN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2407
Mailing Address - Country:US
Mailing Address - Phone:410-737-8780
Mailing Address - Fax:410-737-8781
Practice Address - Street 1:1335 LINDEN AVE
Practice Address - Street 2:STE 1
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-2407
Practice Address - Country:US
Practice Address - Phone:410-737-8780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057747207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD221052Medicare PIN