Provider Demographics
NPI:1124550132
Name:OMOSULE, AYODEJI JOSHUA (MBBS, MHA)
Entity Type:Individual
Prefix:
First Name:AYODEJI
Middle Name:JOSHUA
Last Name:OMOSULE
Suffix:
Gender:M
Credentials:MBBS, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MARYLAND, ST JOSEPH MEDICAL CENTER
Mailing Address - Street 2:8322 BELLONA AVENUE, SUITE 330
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-825-6945
Mailing Address - Fax:410-825-8974
Practice Address - Street 1:8322 BELLONA AVE STE 330
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2077
Practice Address - Country:US
Practice Address - Phone:410-825-6945
Practice Address - Fax:410-825-8974
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112096207L00000X
MDD0090521207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology