Provider Demographics
NPI:1871558965
Name:ADEWUNMI, OLUYEMISI O (MD)
Entity type:Individual
Prefix:
First Name:OLUYEMISI
Middle Name:O
Last Name:ADEWUNMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 MARIETTA STATION DR
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9138
Mailing Address - Country:US
Mailing Address - Phone:301-306-8990
Mailing Address - Fax:301-306-8229
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-306-8990
Practice Address - Fax:301-306-8229
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400415900Medicaid
MD400415900Medicaid
MDKR65F036Medicare ID - Type Unspecified