Provider Demographics
NPI:1972595502
Name:MEDICAL TOWERS, LLC
Entity Type:Organization
Organization Name:MEDICAL TOWERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUSEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-655-7100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKAU5OtherCAREFIRST BLUE SHIELD
MDW357OtherFEP/ BLUE CHOICE/ CAPITOL
MDW357OtherFEP/ BLUE CHOICE/ CAPITOL