Provider Demographics
NPI:1245910256
Name:OGUNYOSOYE, OLUBUKOLA (MD)
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:OGUNYOSOYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MORNING CT
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2167
Mailing Address - Country:US
Mailing Address - Phone:443-983-8494
Mailing Address - Fax:
Practice Address - Street 1:4 MORNING CT
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2167
Practice Address - Country:US
Practice Address - Phone:443-983-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01329374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide