Healthcare Provider Details

I. General information

NPI: 1518191493
Provider Name (Legal Business Name): OLUBUSOLA GOMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N STE 104
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

458 ELIZABETH AVE STE 5-383
SOMERSET NJ
08873-5110
US

V. Phone/Fax

Practice location:
  • Phone: 908-340-0027
  • Fax:
Mailing address:
  • Phone: 908-340-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58764
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number58764
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number0101262025
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number25MA08986700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: