Provider Demographics
NPI:1689005043
Name:OLUGBOJA, BOLAJI
Entity Type:Individual
Prefix:DR
First Name:BOLAJI
Middle Name:
Last Name:OLUGBOJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 LIBERTY RD STE B
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4832
Mailing Address - Country:US
Mailing Address - Phone:410-301-6767
Mailing Address - Fax:410-496-3121
Practice Address - Street 1:8515 LIBERTY RD STE B
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4832
Practice Address - Country:US
Practice Address - Phone:410-301-6767
Practice Address - Fax:410-496-3121
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178347207QA0401X, 363LF0000X, 363LP0808X
MDR210237363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care