Individual provider Active NPI

Gbenga Damilare Lawal

  • Student in an Organized Health Care Education/Training Program
  • Hagerstown, MD
National Provider Identifier
1851272520
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
11110 Medical Campus Rd Ste 200
Hagerstown, MD 21742-6797
Phone
(301) 714-4400
NPI assigned
Sep 10, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

11110 Medical Campus Rd Ste 200
Hagerstown, MD 21742-6797

Mailing address

14 Patti LN
Hagerstown, MD 21740-2398
Phone (570) 909-8212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251229001182 MD Order and Referring Only - Family PracticePractitioner - Family Practice 4385130418

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1851272520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 PATTI LN",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217402398",
            "telephone_number": "570-909-8212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD STE 200",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426797",
            "telephone_number": "301-714-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWAL",
        "first_name": "GBENGA",
        "middle_name": "DAMILARE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-10",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.