Healthcare Provider Details

I. General information

NPI: 1477144087
Provider Name (Legal Business Name): OLUBUKOLA A OGUNKUA MD, MPH, MHS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BUKOLA A OGUNKUA MD, MPH, MHS, LPC

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 THOMAS RD STE 100
PLYMOUTH MEETING PA
19462-2857
US

IV. Provider business mailing address

1030 THOMAS RD STE 100
PLYMOUTH MEETING PA
19462-2857
US

V. Phone/Fax

Practice location:
  • Phone: 267-608-7548
  • Fax:
Mailing address:
  • Phone: 267-608-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC007564
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: