Provider Demographics
NPI:1073076238
Name:OMOTOSHO, YETUNDE BERNICE (MD)
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:BERNICE
Last Name:OMOTOSHO
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:BUILDING 10-CRC 10 CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-8409
Mailing Address - Country:US
Mailing Address - Phone:301-451-6419
Mailing Address - Fax:301-480-5491
Practice Address - Street 1:NIH CLINICAL CENTER
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-8409
Practice Address - Country:US
Practice Address - Phone:301-496-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.074323207R00000X
DCMD21000870207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine