Provider Demographics
NPI:1023644762
Name:ELUDOYIN, OLUDAPO RAPHAEL (FNP)
Entity type:Individual
Prefix:
First Name:OLUDAPO
Middle Name:RAPHAEL
Last Name:ELUDOYIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 CHARLES EDWARD TER
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5147
Mailing Address - Country:US
Mailing Address - Phone:410-491-0962
Mailing Address - Fax:410-997-1820
Practice Address - Street 1:7060 OAKLAND MILLS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1694
Practice Address - Country:US
Practice Address - Phone:410-491-0962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR146815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily