Basic Information
| Provider Information | |||||||||
| NPI: | 1154322352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IBITOYE | ||||||||
| FirstName: | OKEOWO | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64916 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816573 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 MEDICAL PKWY | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0051437 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 60389103 | 01 | BCBS-MD | OTHER | 689LD128 | 01 | MEDICARE PIN | OTHER | 723540200 | 01 | AMERIGROUP - AMERICAID | OTHER | 1154322352 | 01 | NPI NUMBER | OTHER | 5861765 | 01 | AETNA / US HEALTHCARE | OTHER | 689LD128 | 01 | WELLCARE | OTHER | G71393 | 01 | UPIN | OTHER | 0481822 | 01 | MAMSI | OTHER | 723540200 | 05 | MD | MEDICAID | 0001 | 01 | BCBS-DC | OTHER | 0039732900 | 01 | FEDERAL BLACK LUNG BENEFITS | OTHER | 21699 | 01 | JHHC | OTHER | 521169362 | 01 | KAISER PERMANENTE | OTHER | AH01 | 01 | ENVOY SITE ID | OTHER | 110178760 | 01 | RAILROAD MEDICARE-PALMETTO | OTHER | 2452142 | 01 | AETNA/US HEALTHCARE HMO | OTHER | 521169362 | 01 | MULTIPLAN | OTHER | 521169362 | 01 | AMERICHOICE | OTHER | D51437 | 01 | MEDICAL LICENSE | OTHER |