Active NPI
Olufunke S Pickering, M.D. MBA
- Pediatrics Physician
- Baltimore, MD
National Provider Identifier
1093960130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0068784
- Practice address
- 111 N Charles St
Baltimore, MD 21201-3803 - Phone
- (410) 837-2050
- NPI assigned
- Nov 17, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 60251065 | NY | |
| Pediatrics Physician | 208000000X | 046982 | CT | |
| Pediatrics Physician | 208000000X | D0068784 | MD | Primary |
Addresses
Primary practice location
111 N Charles St
Baltimore, MD 21201-3803
Mailing address
1111 N Charles St
112
Baltimore, MD 21201-7428
Phone (410) 837-2050
Other names 1
- Olufunke S Olumegbon
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Business Administration, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046982 | CT | MD | Pediatrics Physician |
| D0068784 | MD | MD | Pediatrics Physician |
| 60251065 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Potomac Physicians PA | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644278400000",
"number": "1093960130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 N CHARLES ST",
"address_2": "112",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212017428",
"telephone_number": "410-837-2050"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N CHARLES ST",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212013803",
"telephone_number": "410-837-2050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKERING",
"first_name": "OLUFUNKE",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "M.D. MBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-17",
"last_updated": "2022-02-08",
"certification_date": "2022-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "60251065",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "046982",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0068784",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "OLUFUNKE",
"last_name": "OLUMEGBON",
"middle_name": "S",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.