Provider Demographics
NPI:1760207930
Name:EGBEOLA, BENJAMIN OLUWATOYIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:OLUWATOYIN
Last Name:EGBEOLA
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 1:3604 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2412
Mailing Address - Country:US
Mailing Address - Phone:202-800-4433
Mailing Address - Fax:
Practice Address - Street 1:3019 MARTIN LUTHER KING JR
Practice Address - Street 2:AVE SE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-800-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health