Healthcare Provider Details

I. General information

NPI: 1689291676
Provider Name (Legal Business Name): ABIDEMI OLASUNMBO ONABADEJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ALABAMA AVE SE STE 238
WASHINGTON DC
20032-4542
US

IV. Provider business mailing address

1100 ALABAMA AVE SE STE 238
WASHINGTON DC
20032-4542
US

V. Phone/Fax

Practice location:
  • Phone: 202-299-5334
  • Fax:
Mailing address:
  • Phone: 202-299-5334
  • Fax:

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: