Healthcare Provider Details

I. General information

NPI: 1740642453
Provider Name (Legal Business Name): OLUBUSOLA OLUWOLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 02/24/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 FITH AVENUE 5TH FLOOR
PITTSBURGH PA
15213-2739
US

IV. Provider business mailing address

3708 5TH AVE STE 4
PITTSBURGH PA
15213-3427
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-2345
  • Fax:
Mailing address:
  • Phone: 412-647-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD479555
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD61088026
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: