MEDICARE: OLUWATOMISIN ELIZABETH OLASIMBO PA-C

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1790507283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUWATOMISIN ELIZABETH OLASIMBO PA-C

Provider Business Mailing Address
First Line	:	6220 OLD DOBBIN LN STE 180
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5812
Country	:	US
Telephone Number	:	410-964-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 OLD DOBBIN LN STE 200
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-5813
Country	:	US
Telephone Number	:	410-964-5300
Fax Number	:	410-964-5300

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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