Healthcare Provider Details

I. General information

NPI: 1225328099
Provider Name (Legal Business Name): OLUGBENGA O OBASANJO MBBS MPH PHD FACPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CENTRAL PARK BLVD STE 300
FREDERICKSBURG VA
22401-4954
US

IV. Provider business mailing address

1320 CENTRAL PARK BLVD STE 300
FREDERICKSBURG VA
22401-4954
US

V. Phone/Fax

Practice location:
  • Phone: 540-322-5930
  • Fax:
Mailing address:
  • Phone: 540-322-5930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101247970
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101247970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: