Healthcare Provider Details

I. General information

NPI: 1477519742
Provider Name (Legal Business Name): OLUBUNMI LAMPEJO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 KINGSLEY LANE
NORFOLK VA
23505
US

IV. Provider business mailing address

PO BOX 758994
BALTIMORE MD
21275-6412
US

V. Phone/Fax

Practice location:
  • Phone: 757-889-5069
  • Fax:
Mailing address:
  • Phone: 800-353-0788
  • Fax: 804-355-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number010123591
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: