Provider Demographics
NPI:1740430305
Name:ISAACS, IBUKUN-OLU AKINYEMI (MD)
Entity Type:Individual
Prefix:DR
First Name:IBUKUN-OLU
Middle Name:AKINYEMI
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IBUKUN OLU
Other - Middle Name:AKINYEMI
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD,
Mailing Address - Street 1:23507 HOLLYWOOD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-5833
Mailing Address - Country:US
Mailing Address - Phone:301-475-8860
Mailing Address - Fax:301-473-3843
Practice Address - Street 1:23507 HOLLYWOOD RD STE 2
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-5833
Practice Address - Country:US
Practice Address - Phone:301-475-8860
Practice Address - Fax:301-473-3843
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00718452084P0804X
VAFI12577632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1740430305Medicaid