Healthcare Provider Details

I. General information

NPI: 1386496040
Provider Name (Legal Business Name): TOPE OLONIYO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OLUBUKOLA OPE OLONIYO MD

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N DUPONT HWY
NEW CASTLE DE
19720-1100
US

IV. Provider business mailing address

6807 VISTA LEDGE DR
BAYTOWN TX
77521-2995
US

V. Phone/Fax

Practice location:
  • Phone: 972-997-1783
  • Fax:
Mailing address:
  • Phone: 972-997-1783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC7-0018509
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: