Healthcare Provider Details

I. General information

NPI: 1053774604
Provider Name (Legal Business Name): OLUWATOSIN OLADEINDE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTENNIAL ST UNIT 1052
LA PLATA MD
20646-7539
US

IV. Provider business mailing address

100 CENTENNIAL ST UNIT 1052
LA PLATA MD
20646-7539
US

V. Phone/Fax

Practice location:
  • Phone: 301-753-3454
  • Fax:
Mailing address:
  • Phone: 301-753-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.013673
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102206778
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0098792
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: