Healthcare Provider Details

I. General information

NPI: 1760989628
Provider Name (Legal Business Name): OLUWAFUNMILAYO IFEOLU ATANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLUWAFUNMILAYO IFEOLU ATANDA MD

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVENUE NW
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

205 ROLLINS AVE
ROCKVILLE MD
20852-4011
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 240-615-7667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101277867
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: