Healthcare Provider Details

I. General information

NPI: 1942477005
Provider Name (Legal Business Name): OLUBUKOLA OJUOLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 WARDS ROAD
LYNCHBURG VA
24502-2101
US

IV. Provider business mailing address

2321 WARDS ROAD
LYNCHBURG VA
24502-2101
US

V. Phone/Fax

Practice location:
  • Phone: 434-582-2273
  • Fax: 434-582-1363
Mailing address:
  • Phone: 434-582-2273
  • Fax: 434-582-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101244761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: