Provider Demographics
NPI:1952560385
Name:OJUMU, ADENIKE MODUPE
Entity Type:Individual
Prefix:MS
First Name:ADENIKE
Middle Name:MODUPE
Last Name:OJUMU
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 1:6417 PHANTOM MOON WALK
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1283
Mailing Address - Country:US
Mailing Address - Phone:410-504-2426
Mailing Address - Fax:
Practice Address - Street 1:39 BRIGHT SKY CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1781
Practice Address - Country:US
Practice Address - Phone:410-504-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD767MMedicare UPIN