Healthcare Provider Details

I. General information

NPI: 1952220659
Provider Name (Legal Business Name): TOLULOPE OLUWAYEMISI FASHOLA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 COVENTRY STREET, BURGDORF CLINIC 2ND FLOOR, HARTFORD, CT 06112
HARTFORD CT
06112
US

IV. Provider business mailing address

131 COVENTRY STREET, BURGDORF CLINIC 2ND FLOOR, HARTFORD, CT 06112
HARTFORD CT
06112
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-3690
  • Fax: 860-714-8541
Mailing address:
  • Phone: 860-714-3690
  • Fax: 860-714-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: