Healthcare Provider Details

I. General information

NPI: 1093923229
Provider Name (Legal Business Name): OLAYINKA MICHAEL JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 N HAMMONDS FERRY RD SUITE C
LINTHICUM MD
21090-1301
US

IV. Provider business mailing address

6020 HELEN DORSEY WAY
COLUMBIA MD
21045-5046
US

V. Phone/Fax

Practice location:
  • Phone: 410-789-2500
  • Fax: 410-789-2501
Mailing address:
  • Phone: 410-964-5711
  • Fax: 410-964-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberD0055180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: