Healthcare Provider Details

I. General information

NPI: 1457379497
Provider Name (Legal Business Name): OLUBUNMI K ABAYOMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL STREET RADIATION ONCOLOGY
RICHMOND VA
23298-0058
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7232
  • Fax: 804-828-6042
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number0101231689
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: