Healthcare Provider Details

I. General information

NPI: 1912017690
Provider Name (Legal Business Name): FOLA OLUWEHINMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FOLA FAWEHINMI

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/27/2023
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 WILLIAMS DR STE 300 INTERNAL MEDICINE/GERIATRICS
FAIRFAX VA
22031-4600
US

IV. Provider business mailing address

3022 WILLIAMS DR STE 300
FAIRFAX VA
22031-4600
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-9800
  • Fax: 703-573-2959
Mailing address:
  • Phone: 703-573-9800
  • Fax: 703-573-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101253418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: