Provider Demographics
NPI:1881608727
Name:AKINJAGUNLA, OLAKITAN TOMI (MD)
Entity type:Individual
Prefix:DR
First Name:OLAKITAN
Middle Name:TOMI
Last Name:AKINJAGUNLA
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 1:11506 BRIGIT CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4417
Mailing Address - Country:US
Mailing Address - Phone:301-793-4776
Mailing Address - Fax:
Practice Address - Street 1:1000 PINE STREET
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:903-798-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2084207P00000X, 207R00000X
VA0101055006207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881608727Medicaid
TX148976711Medicaid
WV3810012611Medicaid
WV3810012611Medicaid
G55400Medicare UPIN
VA017845U26Medicare PIN