Provider Demographics
NPI:1154511889
Name:OLUMOKO, TEMITOPE A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TEMITOPE
Middle Name:A
Last Name:OLUMOKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TEMITOPE
Other - Middle Name:A
Other - Last Name:OMONIYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1940 W BALTIMORE ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2245
Mailing Address - Country:US
Mailing Address - Phone:410-362-3612
Mailing Address - Fax:
Practice Address - Street 1:1940 W BALTIMORE ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2245
Practice Address - Country:US
Practice Address - Phone:410-362-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03017363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical