Provider Demographics
NPI:1780605600
Name:OLASEWERE, OYINLOLA A (PA)
Entity type:Individual
Prefix:MS
First Name:OYINLOLA
Middle Name:A
Last Name:OLASEWERE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 HEALTH CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-6378
Mailing Address - Country:US
Mailing Address - Phone:204-515-5774
Mailing Address - Fax:
Practice Address - Street 1:15001 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1017
Practice Address - Country:US
Practice Address - Phone:204-515-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical