1073307161 NPI number — OLUWATOMISIN OYEFUNKE OYEWOLE MD

Table of content: OLUWATOMISIN OYEFUNKE OYEWOLE MD (NPI 1073307161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073307161 NPI number — OLUWATOMISIN OYEFUNKE OYEWOLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OYEWOLE
Provider First Name:
OLUWATOMISIN
Provider Middle Name:
OYEFUNKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1073307161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 HARRY S TRUMAN DR N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20774-5477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
240-677-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 GARDEN CITY DR STE 810
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HYATTSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20785-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-677-3100
Provider Business Practice Location Address Fax Number:
301-851-5600
Provider Enumeration Date:
04/05/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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