Provider Demographics
NPI:1598252371
Name:WAYNE MEDICAL ASSOCIATE, INC.
Entity Type:Organization
Organization Name:WAYNE MEDICAL ASSOCIATE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUREMI
Authorized Official - Middle Name:T
Authorized Official - Last Name:ILUPEJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-477-4093
Mailing Address - Street 1:7207 HANOVER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2089
Mailing Address - Country:US
Mailing Address - Phone:301-477-4093
Mailing Address - Fax:240-553-7045
Practice Address - Street 1:7207 HANOVER PKWY STE A
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2089
Practice Address - Country:US
Practice Address - Phone:301-477-4093
Practice Address - Fax:240-553-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD454720207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty