Healthcare Provider Details

I. General information

NPI: 1952786840
Provider Name (Legal Business Name): MFON VALENCIA UMOREN ELEGBEDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10045 RED RUN BLVD STE 135
OWINGS MILLS MD
21117-5916
US

IV. Provider business mailing address

10045 RED RUN BLVD STE 135
OWINGS MILLS MD
21117-5916
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-2240
  • Fax: 410-363-3858
Mailing address:
  • Phone: 410-363-2240
  • Fax: 410-363-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0093838
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: