Healthcare Provider Details

I. General information

NPI: 1003115387
Provider Name (Legal Business Name): TOLULOPE ADESIYUN AGUNBIADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOLULOPE ADEBISI ADESIYUN MD

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD STE C2
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-8900
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberFA5309504
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberFA5309504
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25MA11567700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: