Healthcare Provider Details

I. General information

NPI: 1497577829
Provider Name (Legal Business Name): FREDRICK OLAYIWOLA DOPEMU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2646
US

IV. Provider business mailing address

5615 ANNAPOLIS RD
BLADENSBURG MD
20710-2205
US

V. Phone/Fax

Practice location:
  • Phone: 202-827-9961
  • Fax: 202-827-9963
Mailing address:
  • Phone: 432-999-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberMT0158723
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: