Healthcare Provider Details

I. General information

NPI: 1093960130
Provider Name (Legal Business Name): OLUFUNKE S PICKERING M.D. MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUFUNKE S OLUMEGBON M.D.

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 02/08/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N CHARLES ST
BALTIMORE MD
21201-3803
US

IV. Provider business mailing address

1111 N CHARLES ST 112
BALTIMORE MD
21201-7428
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-2050
  • Fax:
Mailing address:
  • Phone: 410-837-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60251065
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046982
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0068784
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: