Provider Demographics
NPI:1225093768
Name:ILUPEJU, OLUREMI T (MD)
Entity Type:Individual
Prefix:
First Name:OLUREMI
Middle Name:T
Last Name:ILUPEJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12150 ANNAPOLIS RD STE 212
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:301-439-4422
Mailing Address - Fax:301-439-0968
Practice Address - Street 1:7221 HANOVER PKWY STE C
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2022
Practice Address - Country:US
Practice Address - Phone:301-439-4422
Practice Address - Fax:301-439-0968
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033392208D00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
420988Medicare ID - Type Unspecified
E63727Medicare UPIN