Healthcare Provider Details

I. General information

NPI: 1649253485
Provider Name (Legal Business Name): MODUPE OLUWAFUNMILAYO OBADINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 HANOVER PKWY SUITE A
GREENBELT MD
20770-3618
US

IV. Provider business mailing address

7325 HANOVER PKWY SUITE A
GREENBELT MD
20770-3618
US

V. Phone/Fax

Practice location:
  • Phone: 301-345-3966
  • Fax: 301-982-2937
Mailing address:
  • Phone: 301-345-3966
  • Fax: 301-982-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0043159
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0043159
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: