Healthcare Provider Details

I. General information

NPI: 1518641521
Provider Name (Legal Business Name): OMOJOLADE OGUNDIYA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 STEVENS FOREST RD STE 107
COLUMBIA MD
21046-3240
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 443-367-4700
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1099326
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAC005534
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: