Individual
OLANREWAJU W ETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 E 25TH ST, BALTIMORE, MD 21218-5304
(410) 889-3000
(410) 889-3003
Mailing address
402 E 25TH ST, BALTIMORE, MD 21218-5304
(410) 889-3000
(410) 889-3003
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4436004067
CELLPHONE NUMBER
MD
Enumeration date
03/20/2020
Last updated
03/20/2020
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