Healthcare Provider Details

I. General information

NPI: 1750217477
Provider Name (Legal Business Name): ODUNAYO SUSAN LAWAL MD,PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 W BALTIMORE ST
BALTIMORE MD
21201-1510
US

IV. Provider business mailing address

9206 LEAHS LN
OWINGS MILLS MD
21117-4833
US

V. Phone/Fax

Practice location:
  • Phone: 202-763-1224
  • Fax:
Mailing address:
  • Phone: 202-763-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: