Provider Demographics
NPI:1093923229
Name:JOHNSON, OLAYINKA MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 HELEN DORSEY WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5046
Mailing Address - Country:US
Mailing Address - Phone:410-964-5711
Mailing Address - Fax:410-964-5711
Practice Address - Street 1:809 N HAMMONDS FERRY RD
Practice Address - Street 2:SUITE C
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-1301
Practice Address - Country:US
Practice Address - Phone:410-789-2500
Practice Address - Fax:410-789-2501
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00551802084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014146100Medicaid
MD014146100Medicaid
H22255Medicare UPIN