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NPI Code Detail

MEDICARE: DR. IFEOLUWA Y OMITOWOJU MD

MEDICARE: DR. IFEOLUWA Y OMITOWOJU 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
1208000000XPediatrics PhysicianD0059049MD

General Provider Information

NPI Number : 1629068903
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IFEOLUWA Y OMITOWOJU MD
Provider Business Mailing Address
First Line : 2101 E JEFFERSON ST
Second Line : KAISER PERMANENTE MEDICARE ENROLLMENT
City : ROCKVILLE
State : MD
Zip : 20852-4908
Country : US
Telephone Number : 301-816-2424
Fax Number :
Provider Business Practice Location Address
First Line : 1701 TWIN SPRINGS RD
Second Line : KAISER PERMANENTE SOUTH BALTIMORE COUNTY HUB
City : HALETHORPE
State : MD
Zip : 21227-3553
Country : US
Telephone Number : 410-737-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 06/25/2021

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