Medical Legacy LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

D0023724 Issued in MD

Legal business name

MEDICAL LEGACY LLC

Practice address

5310 Old Court Rd
Suite 305
Randallstown, MD 21133-5243

Phone

(410) 655-7100

Fax

(410) 655-7917

NPI assigned

Jun 27, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Olutoyin A Okunoren, RD

Title

Practice Coordinator

Phone

(410) 655-7100

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214524800000",
    "number": "1114189453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 OLD COURT RD",
            "address_2": "SUITE 305",
            "city": "RANDALLSTOWN",
            "state": "MA",
            "postal_code": "21133",
            "telephone_number": "410-655-7100",
            "fax_number": "410-655-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 OLD COURT RD",
            "address_2": "SUITE 305",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335243",
            "telephone_number": "410-655-7100",
            "fax_number": "410-655-7917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL LEGACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2008-06-27",
        "status": "A",
        "authorized_official_last_name": "OKUNOREN",
        "authorized_official_first_name": "OLUTOYIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE COORDINATOR",
        "authorized_official_telephone_number": "410-655-7100",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0023724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255951000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Randallstown, MD
• Providers in Randallstown, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.