MEDICARE: DR. AKINNIYI BABASOLA ODUTOLA M.D.

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	208000000X	Pediatrics Physician	210668	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32424	OTHER	MA	PROVIDER HNE #
2	97431403	OTHER	MA	NETWORK HEALTH
3	2450995	OTHER		UNITED HEALTHCARE #
4	8207136	OTHER	MA	CIGNA
5	MO0497950A	OTHER	MA	CSR NUMBER
6	210668	OTHER		PROVIDER CONNECTICARE #
7	3842111	OTHER		AETNA #
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	692538	OTHER		TUFTS #
10	000000049829	OTHER	MA	BMC HEALTHNET #
11	0030525	OTHER	MA	NEIGHBORHOOD HEALTH PLAN #
12	49849	OTHER	MA	PROVIDER CHILDRENS MEDICAL SECURITY PLAN #
13	J25872	OTHER	MA	BC/BS NUMBER

General Provider Information

NPI Number	:	1588629240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AKINNIYI BABASOLA ODUTOLA M.D.

Provider Business Mailing Address
First Line	:	84 LAWRENCE DR
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-1618
Country	:	US
Telephone Number	:	413-241-6152
Fax Number	:	413-241-6153

Provider Business Practice Location Address
First Line	:	475 SUMNER AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01108-2321
Country	:	US
Telephone Number	:	413-241-6152
Fax Number	:	413-241-6153

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	03/07/2023

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