Healthcare Provider Details

I. General information

NPI: 1043847007
Provider Name (Legal Business Name): OLUDOLAPO ILORI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CROSSROADS DR STE 340
OWINGS MILLS MD
21117-5492
US

IV. Provider business mailing address

23 CROSSROADS DR STE 340
OWINGS MILLS MD
21117-5492
US

V. Phone/Fax

Practice location:
  • Phone: 410-653-0366
  • Fax: 410-601-4759
Mailing address:
  • Phone: 410-653-0366
  • Fax: 410-601-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD97688
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0097688
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: