Healthcare Provider Details

I. General information

NPI: 1144875139
Provider Name (Legal Business Name): AKINYELE LAWRENCE AKINYOOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 WOODS WAY
STATE FARM VA
23160-0004
US

IV. Provider business mailing address

9218 SAXSAWN LN
CHESTERFIELD VA
23832-2843
US

V. Phone/Fax

Practice location:
  • Phone: 832-759-0801
  • Fax:
Mailing address:
  • Phone: 832-759-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number0101273846
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101273846
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: