Healthcare Provider Details

I. General information

NPI: 1629949623
Provider Name (Legal Business Name): BABATUNDE AYODELE OKUNUGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 PARK HEIGHTS AVE STE 4
PIKESVILLE MD
21208-5497
US

IV. Provider business mailing address

7894 PEPPERBOX LN
PASADENA MD
21122-6372
US

V. Phone/Fax

Practice location:
  • Phone: 443-759-8965
  • Fax:
Mailing address:
  • Phone: 929-499-4329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: