Provider Demographics
NPI:1154322352
Name:IBITOYE, OKEOWO D (MD)
Entity Type:Individual
Prefix:DR
First Name:OKEOWO
Middle Name:D
Last Name:IBITOYE
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:PO BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6573
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
60389103OtherBCBS-MD
689LD128OtherMEDICARE PIN
723540200OtherAMERIGROUP - AMERICAID
1154322352OtherNPI NUMBER
5861765OtherAETNA / US HEALTHCARE
689LD128OtherWELLCARE
G71393OtherUPIN
0481822OtherMAMSI
MD723540200Medicaid
0001OtherBCBS-DC
0039732900OtherFEDERAL BLACK LUNG BENEFITS
21699OtherJHHC
521169362OtherKAISER PERMANENTE
AH01OtherENVOY SITE ID
110178760OtherRAILROAD MEDICARE-PALMETTO
2452142OtherAETNA/US HEALTHCARE HMO
521169362OtherMULTIPLAN
521169362OtherAMERICHOICE
D51437OtherMEDICAL LICENSE