MEDICARE: DR. OLABUNMI A. AGBOOLA 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	207K00000X	Allergy & Immunology Physician	2014-00817	NC
2	207K00000X	Allergy & Immunology Physician	MD046677	DC
3	208M00000X	Hospitalist Physician	D87384	MD
4	208M00000X	Hospitalist Physician	2014-00817	NC
5	207K00000X	Allergy & Immunology Physician	D87384	MD

General Provider Information

NPI Number	:	1861719023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLABUNMI A. AGBOOLA M.D.

Provider Business Mailing Address
First Line	:	660 PENNSYLVANIA AVE SE STE 101
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-4354
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	:	04/28/2010
Last Update Date	:	02/24/2022

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