Organization
RADIANCE DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMOLARA OLOWOYEYE MD (OWNER)
(301) 430-4000
Entity
Organization
Contact information
Practice address
10215 FERNWOOD RD STE 414, BETHESDA, MD 20817-1191
(301) 430-4000
(301) 430-4040
Mailing address
10215 FERNWOOD RD STE 414, BETHESDA, MD 20817-1191
(301) 430-4000
(301) 430-4040
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0081771
MEDICAL LICENSE
MD
Enumeration date
06/10/2019
Last updated
06/10/2019
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