Provider Demographics
NPI:1598755373
Name:OFFURUM, ADA I (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:I
Last Name:OFFURUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADA
Other - Middle Name:U
Other - Last Name:IBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-5793
Mailing Address - Fax:410-328-0248
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5793
Practice Address - Fax:410-328-0248
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD057761207R00000X
MDD57751208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034350700Medicaid
DE1000021653Medicaid
MD755103700Medicaid
MD613252-01 & 02OtherBC/BS
DE1000021653Medicaid
MD387657Y1PMedicare PIN
MD613252-01 & 02OtherBC/BS
MD755103700Medicaid