Healthcare Provider Details

I. General information

NPI: 1902594708
Provider Name (Legal Business Name): TEMITOPE JOYCE OGUNDIPE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEMITOPE JOYCE DAVID MD

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 MEDICAL CAMPUS RD
HAGERSTOWN MD
21742-6710
US

IV. Provider business mailing address

2235 CONQUEST WAY
ODENTON MD
21113-2679
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-8000
  • Fax:
Mailing address:
  • Phone: 443-712-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0104742
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW0894
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: