Healthcare Provider Details

I. General information

NPI: 1295879005
Provider Name (Legal Business Name): BOLANLE M FAMAKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NATIONAL INSTITUTES OF HEALTH NINDS, STROKE BRANCH, BUILDING 49, MSC 4476
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

NATIONAL INSTITUTES OF HEALTH NINDS, STROKE BRANCH, BUILDING 49, MSC 4476
BETHESDA MD
20892-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-402-6936
  • Fax:
Mailing address:
  • Phone: 301-402-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number054876
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberD63344
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: