Healthcare Provider Details

I. General information

NPI: 1639733405
Provider Name (Legal Business Name): MOBOLAJI FALOMO AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 OLD CHAIN BRIDGE RD STE 185
MC LEAN VA
22101-3945
US

IV. Provider business mailing address

351 DALEVIEW DR
GLEN BURNIE MD
21060-7683
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-8110
  • Fax: 703-942-8042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01455
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: