Healthcare Provider Details

I. General information

NPI: 1245910256
Provider Name (Legal Business Name): OLUBUKOLA OGUNYOSOYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MORNING CT
ROSEDALE MD
21237-2167
US

IV. Provider business mailing address

4 MORNING CT
ROSEDALE MD
21237-2167
US

V. Phone/Fax

Practice location:
  • Phone: 443-983-8494
  • Fax:
Mailing address:
  • Phone: 443-983-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberRSA-01329
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: