MEDICARE: DR. ISHAQ OLAYINKA GIWA DNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R199309	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	199309	MD

General Provider Information

NPI Number	:	1710643564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISHAQ OLAYINKA GIWA DNP

Provider Business Mailing Address
First Line	:	8205 REECEWOOD DR
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-3049
Country	:	US
Telephone Number	:	410-499-3997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 N BROADWAY STE 101
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-1444
Country	:	US
Telephone Number	:	410-366-1893
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	07/24/2023

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