MEDICARE: DR. MODUPE ODUNUGA 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
1	208000000X	Pediatrics Physician	D45663	MD
2	2080A0000X	Pediatric Adolescent Medicine Physician	D45663	MD

General Provider Information

NPI Number	:	1871588079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MODUPE ODUNUGA MD

Provider Business Mailing Address
First Line	:	18 NANTUCKET CT
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-4423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6122 LANDOVER RD
Second Line	:
City	:	CHEVERLY
State	:	MD
Zip	:	20785-1016
Country	:	US
Telephone Number	:	301-322-2411
Fax Number	:	301-322-2412

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	09/11/2025

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Directions to “ DR. MODUPE ODUNUGA MD” Practice Location

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