Healthcare Provider Details

I. General information

NPI: 1710332267
Provider Name (Legal Business Name): KEHINDE MATILDA FOLAWEWO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD STE 305
FREDERICKSBURG VA
22401-4465
US

IV. Provider business mailing address

1215 STOCKPORT CT
BOWIE MD
20721-1836
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3290
  • Fax:
Mailing address:
  • Phone: 240-346-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD047186
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101272319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: