Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | R178347 | MD |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R178347 | MD |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R178347 | MD |
N | 363LP2300X | Nurse Practitioner - Primary Care | R210237 | MD |
NPI | 1689005043 |
---|---|
Provider Name | Dr. Bolaji Olugboja |
First Address | Randallstown, MD 21133-4832 |
Second Address | Randallstown, MD 21133-4832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2013 |
Last Update Date | 22/12/2021 |