Healthcare Provider Details

I. General information

NPI: 1093824286
Provider Name (Legal Business Name): WOLALI A ODONKOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2041 GEORGIA AVE NW TOWER 3400
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-3290
  • Fax: 202-865-3833
Mailing address:
  • Phone: 202-865-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD32484
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: