Provider Demographics
NPI:1093960130
Name:PICKERING, OLUFUNKE S (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:OLUFUNKE
Middle Name:S
Last Name:PICKERING
Suffix:
Gender:F
Credentials:MD MBA
Other - Prefix:
Other - First Name:OLUFUNKE
Other - Middle Name:S
Other - Last Name:OLUMEGBON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 N CHARLES ST
Mailing Address - Street 2:112
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-7428
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:
Practice Address - Street 1:111 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3803
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60251065208000000X
CT046982208000000X
MDD0068784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics