Fairwood Internal Medicine

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

D0051437 Issued in MD

Legal business name

FAIRWOOD INTERNAL MEDICINE

Practice address

12200 Annapolis Rd
Suite 232
Glenn Dale, MD 20769-9180

Phone

(240) 245-4414

Fax

(240) 245-4409

NPI assigned

Mar 13, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Okeowo Darcy Ibitoye, M.D.NPI 1154322352

Title

Medical Director

Phone

(240) 245-4414

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in DC, MD2 enrollments

Enrollment records 2

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Okeowo D Ibitoye, MD

  • Internal Medicine Physician
  • Annapolis, MD
  • NPI 1154322352

  DC

  Medicare reassignment NPD Authorized official
• Olayinka Abimbola Ibitoye, NP

  • Adult Health Nurse Practitioner
  • Glenn Dale, MD
  • NPI 1588895411
  NPD (past)

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

{
    "created_epoch": "1236902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248134400000",
    "number": "1396986873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "SUITE 232",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699180",
            "telephone_number": "240-245-4414",
            "fax_number": "240-245-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD",
            "address_2": "SUITE 232",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699180",
            "telephone_number": "240-245-4414",
            "fax_number": "240-245-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWOOD INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-13",
        "last_updated": "2009-07-21",
        "status": "A",
        "authorized_official_last_name": "IBITOYE",
        "authorized_official_first_name": "OKEOWO",
        "authorized_official_middle_name": "DARCY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "240-245-4414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D0051437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "723540200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST FEP",
            "identifier": "P366",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MARYLAND",
            "identifier": "DX1GOD",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie Enndoh Ndi
• Corlins Epie Nkede
• Emmy L Estrada, PA-C
• Evidence Physical Therapy, LLC
• Evidence Physical Therapy, LLC
• Faith Transport Inc.
• Kelson Michael Figaro
• Lere Kareem Finnih
• Michele Fonou
• Ngankam Rachel Fonou, HHA

• Internal Medicine Physician in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.