Provider Demographics
NPI:1164892683
Name:BISHOP, OLUFUNMILAYO
Entity Type:Individual
Prefix:
First Name:OLUFUNMILAYO
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18566 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0587
Mailing Address - Country:US
Mailing Address - Phone:301-769-6640
Mailing Address - Fax:301-769-6650
Practice Address - Street 1:18566 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0587
Practice Address - Country:US
Practice Address - Phone:301-769-6640
Practice Address - Fax:301-769-6650
Is Sole Proprietor?:No
Enumeration Date:2015-09-26
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153730363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily