Basic Information
| Provider Information | |||||||||
| NPI: | 1871741108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AJAYI | ||||||||
| FirstName: | OLUWASEYI | ||||||||
| MiddleName: | OLUMIDE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5714235699 | ||||||||
| FaxNumber: | 5714235698 | ||||||||
| Practice Location | |||||||||
| Address1: | 3580 JOSEPH SIEWICK DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033914520 | ||||||||
| FaxNumber: | 7033914521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD-440659 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101261196 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 0101261196 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102547276 | 05 | PA | MEDICAID | 597586 | 01 | PA | MEDICARE TPI GROUP | OTHER | CD4829 | 01 | PA | RAILROAD MEDICARE TPI GROUP | OTHER |