Healthcare Provider Details

I. General information

NPI: 1447336623
Provider Name (Legal Business Name): IBIKUNLE OLAYEMI KOYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 26
LUTHERVILLE MD
21093-6211
US

IV. Provider business mailing address

1589 SULPHUR SPRING RD STE 109
BALTIMORE MD
21227-2542
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-1640
  • Fax: 410-321-5787
Mailing address:
  • Phone: 410-536-5400
  • Fax: 410-737-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD42219
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: