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NPI Code Detail

MEDICARE: DR. DIANA OPEYEMI OMOYENI MD

MEDICARE: DR. DIANA OPEYEMI OMOYENI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianD0103765MD
2207Q00000XFamily Medicine PhysicianMT227172PA

General Provider Information

NPI Number : 1699406652
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIANA OPEYEMI OMOYENI MD
Provider Business Mailing Address
First Line : 6201 GREENLEIGH AVE STE 201
Second Line :
City : MIDDLE RIVER
State : MD
Zip : 21220-2004
Country : US
Telephone Number : 215-482-1234
Fax Number :
Provider Business Practice Location Address
First Line : 10751 FALLS RD STE 304
Second Line :
City : LUTHERVILLE TIMONIUM
State : MD
Zip : 21093-4551
Country : US
Telephone Number : 410-847-3535
Fax Number : 410-367-2236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2022
Last Update Date : 09/08/2025

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