Healthcare Provider Details

I. General information

NPI: 1437418670
Provider Name (Legal Business Name): TIERRA D. OSEJI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 SECURITY BLVD
BALTIMORE MD
21244-1811
US

IV. Provider business mailing address

7141 SECURITY BLVD
BALTIMORE MD
21244-1811
US

V. Phone/Fax

Practice location:
  • Phone: 443-663-6000
  • Fax: 443-663-6276
Mailing address:
  • Phone: 443-663-6000
  • Fax: 443-663-6276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0079740
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: