Samson Olowe, PRESIDENT/CEO

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LP34789 Issued in MD

Practice address

605 Avis Drive
Upper Marlboro, MD 20774

Phone

(301) 221-7553

Fax

(301) 324-0897

NPI assigned

Aug 17, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gosheni LLC

  • Health Service Clinic/Center
  • Upper Marlboro, MD
  • NPI 1679024913
  NPD (past) Authorized official

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1902272784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 AVIS DR",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207742283",
            "telephone_number": "301-221-7553",
            "fax_number": "301-324-0897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 AVIS DRIVE",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "20774",
            "telephone_number": "301-221-7553",
            "fax_number": "301-324-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLOWE",
        "first_name": "SAMSON",
        "credential": "PRESIDENT/CEO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MD",
            "license": "LP34789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kolawole Richard Olatunde, HHA
• Kehinde Olatunji, CRNP, PMHNP-BC
• Olive Tree 1 Care of Maryland
• Olive Tree 1Care
• Ciarrah Oliver
• Grace Olowononi
• Onyeka Oloyede, BCBA
• Alexander A Olufawo
• Babatunde Olujobi, CRNP
• Evelyn Olupona

• Licensed Practical Nurse in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Licensed Practical Nurse in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.