1508157934 NPI number — DR. OLUWAFOYINSAYOMI FASANMI KUMOLUYI MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508157934 NPI number — DR. OLUWAFOYINSAYOMI FASANMI KUMOLUYI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUMOLUYI
Provider First Name:
OLUWAFOYINSAYOMI
Provider Middle Name:
FASANMI
Provider Name Prefix Text:
DR.
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:
FASANMI
Provider Other First Name:
OLUWAFOYINSAYO
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508157934
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17113 LONGLEAF DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20716-3636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-873-3207
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1477 YORK ROAD
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
19718-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-934-0979
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2011

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: 208M00000X , with the licence number:  MD042573 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: D0077909 , 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)





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