Provider Demographics
NPI:1568454197
Name:LAWOYIN, OLUSEGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSEGAN
Middle Name:
Last Name:LAWOYIN
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 1:5310 OLD COURT RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5243
Mailing Address - Country:US
Mailing Address - Phone:410-655-7100
Mailing Address - Fax:410-655-7919
Practice Address - Street 1:5310 OLD COURT RD
Practice Address - Street 2:SUITE 305
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5243
Practice Address - Country:US
Practice Address - Phone:410-655-7100
Practice Address - Fax:410-655-7919
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023724207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32946019OtherCAREFIRST BLUE SHIELD
MD0001OtherFEP/ BLUE CHOICE/ CAPITOL
MD0001OtherFEP/ BLUE CHOICE/ CAPITOL
MD32946019OtherCAREFIRST BLUE SHIELD