Healthcare Provider Details

I. General information

NPI: 1629353339
Provider Name (Legal Business Name): OLAOLUWA O OKUSAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 K ST NE
WASHINGTON DC
20002-4216
US

IV. Provider business mailing address

1100 ALABAMA AVENUE SE ST ELIZABETHS HOSPITAL PSYCHIATRY RESIDENCY PROGRAM
WASHINGTON DC
20032
US

V. Phone/Fax

Practice location:
  • Phone: 202-407-2166
  • Fax:
Mailing address:
  • Phone: 202-213-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD039812
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: