Healthcare Provider Details

I. General information

NPI: 1942549027
Provider Name (Legal Business Name): OLABISI OLADAPO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3357B CORRIDOR MARKETPLACE
LAUREL MD
20724-2381
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 301-497-1820
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC04945
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: