Provider Demographics
NPI:1245818798
Name:ODIMAYOMI, OMOTOKE (MD, MPH)
Entity type:Individual
Prefix:
First Name:OMOTOKE
Middle Name:
Last Name:ODIMAYOMI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FOREST GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1484
Mailing Address - Country:US
Mailing Address - Phone:301-754-7000
Mailing Address - Fax:785-301-8324
Practice Address - Street 1:1500 FOREST GLEN ROAD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1484
Practice Address - Country:US
Practice Address - Phone:301-754-7000
Practice Address - Fax:785-301-8324
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0100089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program