1154322352 NPI number — DR. OKEOWO D IBITOYE MD

Table of content: DR. OKEOWO D IBITOYE MD (NPI 1154322352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154322352 NPI number — DR. OKEOWO D IBITOYE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IBITOYE
Provider First Name:
OKEOWO
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154322352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 64916
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-4916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-481-6573
Provider Business Mailing Address Fax Number:
443-481-6515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-481-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0051437 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60389103 . This is a "BCBS-MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 689LD128 . This is a "MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 723540200 . This is a "AMERIGROUP - AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1154322352 . This is a "NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5861765 . This is a "AETNA / US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 689LD128 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: G71393 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0481822 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 723540200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0001 . This is a "BCBS-DC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0039732900 . This is a "FEDERAL BLACK LUNG BENEFITS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21699 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521169362 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AH01 . This is a "ENVOY SITE ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110178760 . This is a "RAILROAD MEDICARE-PALMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2452142 . This is a "AETNA/US HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521169362 . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521169362 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: D51437 . This is a "MEDICAL LICENSE" identifier . This identifiers is of the category "OTHER".




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