Provider Demographics
NPI:1003626904
Name:IDOWU, OLUWASEUN
Entity type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:
Last Name:IDOWU
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 1:238 ARCADIA SHORES CIR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-4002
Mailing Address - Country:US
Mailing Address - Phone:410-776-4994
Mailing Address - Fax:
Practice Address - Street 1:238 ARCADIA SHORES CIR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-4002
Practice Address - Country:US
Practice Address - Phone:410-776-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP45119376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty