MEDICARE: DR. TAIWO OKUSAMI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101051317	VA

General Provider Information

NPI Number	:	1417036880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAIWO OKUSAMI MD

Provider Business Mailing Address
First Line	:	9 BITTERROOT CT
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20853-1770
Country	:	US
Telephone Number	:	301-367-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	5280 LYNGATE CT
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-1688
Country	:	US
Telephone Number	:	703-217-2487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2006
Last Update Date	:	07/08/2007

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