Healthcare Provider Details

I. General information

NPI: 1932336005
Provider Name (Legal Business Name): OMOIKHEFE GBEMISOLA AKHIGBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 W MARKET PL
FULTON MD
20759-2703
US

IV. Provider business mailing address

11810 W MARKET STREET STE 300
FULTON MD
20759-2703
US

V. Phone/Fax

Practice location:
  • Phone: 301-458-0523
  • Fax:
Mailing address:
  • Phone: 240-425-4824
  • Fax: 240-425-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09567800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0075912
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: