Provider Demographics
NPI:1992509004
Name:AIYENURO, OLUSOLA SAMUEL (MD)
Entity type:Individual
Prefix:MR
First Name:OLUSOLA
Middle Name:SAMUEL
Last Name:AIYENURO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 RAMBLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1755
Mailing Address - Country:US
Mailing Address - Phone:973-524-0115
Mailing Address - Fax:
Practice Address - Street 1:9308 RAMBLEBROOK RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1755
Practice Address - Country:US
Practice Address - Phone:973-524-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-02102374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide