Individual provider Active NPI

Mutiat T Onigbanjo, M.D.

  • Pediatrics Physician
  • Baltimore, MD
National Provider Identifier
1972746279
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
260462 Issued in NY
Practice address
827 Linden Ave
Baltimore, MD 21201-4606
Phone
(410) 225-8780
Fax
(410) 225-8766
NPI assigned
Apr 16, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 260462 NY Primary

Addresses

Primary practice location

827 Linden Ave
Baltimore, MD 21201-4606

Mailing address

PO Box 62063
Baltimore, MD 21264-2063
Phone (410) 706-5181

Other identifiers 1

IdentifierTypeStateIssuer
260462MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160929000650 MD Practitioner - Pediatric Medicine 2567756968 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
260462NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
University of Maryland Pediatric Associates, PA Pediatrics Current Accepting new patients
University of Maryland Pediatric Associates, PA Pediatrics CurrentSince Aug 15, 2016 Accepting new patients
University of Maryland Pediatrics Assoc PA CurrentSince Aug 15, 2016 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

827 Linden Ave
Fl 1
Baltimore, MD 21201
Phone (410) 225-8780

300 Armory Pl
Baltimore, MD 21201
Phone (410) 225-8215

827 Linden Ave
Baltimore, MD 21201
Phone (410) 225-8100

12500 Willowbrook Rd
Cumberland, MD 21502
Phone (240) 964-1255

Interoperability endpoints

  • Direct secure messaging: monigbanjo472171@direct.umm.edu

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1239840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471910400000",
    "number": "1972746279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62063",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212642063",
            "telephone_number": "410-706-5181",
            "fax_number": "410-706-5103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 LINDEN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212014606",
            "telephone_number": "410-225-8780",
            "fax_number": "410-225-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ONIGBANJO",
        "first_name": "MUTIAT",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-16",
        "last_updated": "2016-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "260462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "260462",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.