Provider Demographics
NPI:1043847007
Name:ILORI, OLUDOLAPO
Entity type:Individual
Prefix:
First Name:OLUDOLAPO
Middle Name:
Last Name:ILORI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CROSSROADS DR STE 340
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5492
Mailing Address - Country:US
Mailing Address - Phone:410-653-0366
Mailing Address - Fax:410-601-4759
Practice Address - Street 1:23 CROSSROADS DR STE 340
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5492
Practice Address - Country:US
Practice Address - Phone:410-653-0366
Practice Address - Fax:410-601-4759
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD97688207Q00000X
390200000X
MDD0097688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program