Healthcare Provider Details

I. General information

NPI: 1639949548
Provider Name (Legal Business Name): OLUFEMI S OBASUN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FEMI S OBASUN PHD, DBA

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 BACKLICK CT STE 250USA
SPRINGFIELD VA
22151-3937
US

IV. Provider business mailing address

7007 BACKLICK CT STE 250USA
SPRINGFIELD VA
22151-3937
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-9666
  • Fax:
Mailing address:
  • Phone: 703-214-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberBLA-0000002407
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: