1356929004 NPI number — OLUFUNMILAYO HALIMAT OBISESAN MD, MPH

Table of content: OLUFUNMILAYO HALIMAT OBISESAN MD, MPH (NPI 1356929004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356929004 NPI number — OLUFUNMILAYO HALIMAT OBISESAN MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBISESAN
Provider First Name:
OLUFUNMILAYO
Provider Middle Name:
HALIMAT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABIRU
Provider Other First Name:
OLUFUNMILAYO
Provider Other Middle Name:
HALIMAT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356929004
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E UNIVERSITY PKWY DEPT OF
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:
21218-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-554-2284
Provider Business Mailing Address Fax Number:
410-554-2184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E UNIVERSITY PKWY STE 329
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21218-2829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-554-6872
Provider Business Practice Location Address Fax Number:
410-554-6869
Provider Enumeration Date:
04/01/2021

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)