MEDICARE: YEWANDE IBUKUNOLUWA KOMOLAFE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		MD

General Provider Information

NPI Number	:	1023833571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEWANDE IBUKUNOLUWA KOMOLAFE PA-C

Provider Business Mailing Address
First Line	:	576 OLD TOWN MALL
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21202-4190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 PENNSYLVANIA AVE SE STE 101
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4354
Country	:	US
Telephone Number	:	202-758-2682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	01/14/2026

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