Individual
OLUFEMI OTUBANJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6480 OLD WATERLOO RD, ELKRIDGE, MD 21075-6508
(410) 799-0291
Mailing address
6480 OLD WATERLOO RD, ELKRIDGE, MD 21075-6508
(202) 340-4399
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C004195
MD
363AM0700X
Medical Physician Assistant
C0004195
MD
Other
Enumeration date
06/25/2010
Last updated
05/19/2020
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