Abisola Omowumi Alade, CRNP
Individual provider Active NPI Adult Medicine Physician · Randallstown, MD
NPI 1972140242 · NPPES record last updated Dec 5, 2019
Key facts
- NPI
- 1972140242
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Medicine Physician 207QA0505X
- License
- R213260 (MD)
- Practice address
- 9312 Silver Charm Dr
Randallstown, MD 21133-4610 - Phone
- (443) 743-4699
- NPI assigned
- Dec 5, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R213260 | MD | MD | Adult Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rejuvaris | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | R213260 | MD | Yes |
Addresses
Primary practice location
9312 Silver Charm Dr
Randallstown, MD 21133-4610
Mailing address
9312 Silver Charm Dr
Randallstown, MD 21133-4610
Phone (443) 743-4699
Other providers in Randallstown, MD
- Oluwaseun Ajao
- Taiwo Ikeoluwa Ajao
- Patrick Ajapmou
- Andrea Ajogun
- Tunde Akinsawe
- Alan Lefkowitz, M.D.
- Prosperlyn Alieh
- Bukola Temitope Almaroof
- Rana Alqusairi
- Alyssa Cain LLC
All providers in Randallstown, MD · Adult Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.