Provider Demographics
NPI:1730438763
Name:AGBANIGO, TOBI OLANIPEKUN
Entity type:Individual
Prefix:
First Name:TOBI
Middle Name:OLANIPEKUN
Last Name:AGBANIGO
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 1:3407 DODGE PARK RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2017
Mailing Address - Country:US
Mailing Address - Phone:240-764-7187
Mailing Address - Fax:
Practice Address - Street 1:3407 DODGE PARK RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2017
Practice Address - Country:US
Practice Address - Phone:240-764-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide