Provider Demographics
NPI:1083145338
Name:OMOJOKUN, TOLULOPE OLUBUNMI (MD)
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:OLUBUNMI
Last Name:OMOJOKUN
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 1:10005 OLD COLUMBIA RD STE L260
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1722
Mailing Address - Country:US
Mailing Address - Phone:443-259-0400
Mailing Address - Fax:859-545-4995
Practice Address - Street 1:10005 OLD COLUMBIA RD STE L260
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1722
Practice Address - Country:US
Practice Address - Phone:443-259-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00915242084P0804X, 390200000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry