Healthcare Provider Details

I. General information

NPI: 1760898282
Provider Name (Legal Business Name): TOLA OYESANYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 ORLEANS ST SUITE 206
BALTIMORE MD
21287-0014
US

IV. Provider business mailing address

1447 YORK RD STE 100
LUTHERVILLE MD
21093-6074
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2400
  • Fax: 410-955-8645
Mailing address:
  • Phone: 410-339-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD85240
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: