Provider Demographics
NPI:1144764259
Name:OMUSO, INARA (MD)
Entity type:Individual
Prefix:DR
First Name:INARA
Middle Name:
Last Name:OMUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26005 RIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1899
Mailing Address - Country:US
Mailing Address - Phone:301-414-2300
Mailing Address - Fax:301-414-0476
Practice Address - Street 1:26005 RIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1899
Practice Address - Country:US
Practice Address - Phone:301-414-2300
Practice Address - Fax:301-414-0476
Is Sole Proprietor?:No
Enumeration Date:2016-12-08
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085874207VX0000X
NJ25MA09992500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD907186500Medicaid