Active NPI
Med36-5
- Community/Behavioral Health Agency
- Waldorf, MD
National Provider Identifier
1669388732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- MED36-5
- Practice address
- 3261 Old Washington Rd
Waldorf, MD 20602-3223 - Phone
- (445) 249-7879
- NPI assigned
- Aug 20, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kehinde Tom Ayegunle, MD, MPH, CPRP
- Title
- Ceo
- Phone
- (445) 249-7879
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
3261 Old Washington Rd
Waldorf, MD 20602-3223
Mailing address
3261 Old Washington Rd
Waldorf, MD 20602-3223
Phone (445) 249-7879
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1787184000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1787184000000",
"number": "1669388732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3261 OLD WASHINGTON RD",
"city": "WALDORF",
"state": "MD",
"postal_code": "206023223",
"telephone_number": "445-249-7879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3261 OLD WASHINGTON RD",
"city": "WALDORF",
"state": "MD",
"postal_code": "206023223",
"telephone_number": "445-249-7879"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MED36-5",
"organizational_subpart": "NO",
"enumeration_date": "2026-08-20",
"last_updated": "2026-08-20",
"certification_date": "2026-08-19",
"status": "A",
"authorized_official_last_name": "TOM AYEGUNLE",
"authorized_official_first_name": "KEHINDE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "445-249-7879",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD, MPH, CPRP"
},
"taxonomies": [
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
- Courtney McRae
- Mdics Rehabilitative Services - Ltcaco LLC
- Mdics Rehabilitative Services LLC
- Delia Contreras Meadows, LCSW-C, ICSW, LCSW
- Daniel Jonathan Meckel, PHD LGSW
- Medexpress Urgent Care, PC - Maryland (MedExpress Urgent Care - Waldorf, Crain Hwy)
- Medicine of Essence (Medicine of Essence LLC)
- Medstar Medical Group - Southern Maryland LLC (MedStar Shah Medical Group LLC)
- Medstar Medical Group - Southern Maryland LLC
- Medstar Medical Group - Southern Maryland LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.