Provider Demographics
NPI:1669405270
Name:OLASUPO, ISAAC ABIOYE (MSC)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:ABIOYE
Last Name:OLASUPO
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 JODIE ST
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3636
Mailing Address - Country:US
Mailing Address - Phone:301-345-4787
Mailing Address - Fax:301-345-5310
Practice Address - Street 1:2116 N CHARLES ST
Practice Address - Street 2:SUIT 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5758
Practice Address - Country:US
Practice Address - Phone:410-244-0331
Practice Address - Fax:410-244-7364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD408449700, 409426300103TB0200X
MD101YA0400X, 101YM0800X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation