MEDICARE: DR. GLORIA ADETOKUNBO OJO DNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R145246	MD
2	363LF0000X	Family Nurse Practitioner	R145246	MD

General Provider Information

NPI Number	:	1467799361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA ADETOKUNBO OJO DNP

Provider Business Mailing Address
First Line	:	1412 CRAIN HWY N STE 3A
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-7000
Country	:	US
Telephone Number	:	410-595-5029
Fax Number	:	800-611-7439

Provider Business Practice Location Address
First Line	:	1412 CRAIN HWY N STE 3A
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-7000
Country	:	US
Telephone Number	:	410-595-5029
Fax Number	:	800-611-7439

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

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	03/23/2021

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