Healthcare Provider Details

I. General information

NPI: 1841619566
Provider Name (Legal Business Name): ANUOLUWAPO AKINSANYA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEDICAL PARK BLVD STE 150
PETERSBURG VA
23805-0001
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-765-5206
  • Fax: 804-765-5809
Mailing address:
  • Phone: 804-765-5206
  • Fax: 804-765-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101264865
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: