Healthcare Provider Details

I. General information

NPI: 1710090394
Provider Name (Legal Business Name): OLUYEMISI ADESANYA FAMUYIWA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 TOWER OAKS BLVD SUITE 370
ROCKVILLE MD
20852
US

IV. Provider business mailing address

3202 TOWER OAKS BLVD SUITE 370
ROCKVILLE MD
20852-4219
US

V. Phone/Fax

Practice location:
  • Phone: 301-946-6962
  • Fax: 301-946-6022
Mailing address:
  • Phone: 301-946-6962
  • Fax: 301-946-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberD44906
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberD44906
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberD44906
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberD44906
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD44906
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: