Provider Demographics
NPI:1346332434
Name:OPESANMI, TOYIN OLASUNBO (MD)
Entity Type:Individual
Prefix:DR
First Name:TOYIN
Middle Name:OLASUNBO
Last Name:OPESANMI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12108 EARLY LILACS PATH
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1676
Mailing Address - Country:US
Mailing Address - Phone:410-963-5870
Mailing Address - Fax:410-528-6004
Practice Address - Street 1:1100 W PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2689
Practice Address - Country:US
Practice Address - Phone:410-528-6003
Practice Address - Fax:410-528-6004
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059876207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000911300Medicaid
MD000911300Medicaid