Provider Demographics
NPI:1801487657
Name:AROWOSEGBE, OLUWATOSIN
Entity type:Individual
Prefix:
First Name:OLUWATOSIN
Middle Name:
Last Name:AROWOSEGBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8877 MANAHAN DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5400
Mailing Address - Country:US
Mailing Address - Phone:443-531-5152
Mailing Address - Fax:
Practice Address - Street 1:4380-B MONTGOMERY ROAD #1004
Practice Address - Street 2:
Practice Address - City:ELLICOTT
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:443-531-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health