Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | D61341 | MD |
Y | 111NI0900X | Internist | D61341 | MD |
N | 208000000X | Pediatrician | D61341 | MD |
NPI | 1003848672 |
---|---|
Provider Name | Omolola O Johnson |
First Address | Columbia, MD 21045-5046 |
Second Address | Linthicum, MD 21090-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 22/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49822 | (02) |