Provider Demographics
NPI:1386907921
Name:IGBINOSA, OSAMUYIMEN O (MD)
Entity type:Individual
Prefix:DR
First Name:OSAMUYIMEN
Middle Name:O
Last Name:IGBINOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-0940
Mailing Address - Country:US
Mailing Address - Phone:202-291-4101
Mailing Address - Fax:202-291-4102
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 208 S
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-291-4101
Practice Address - Fax:202-291-4102
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD054743300Medicaid