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General NPI Number Information
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NPI Number | 1306422415
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Entity Type | Individual
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Provider Name | OLAYINKA JOHNSON AGBOOLA MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 8081 INNOVATION PARK DR STE 700
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City | FAIRFAX
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State | VA
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Zip | 22031-4867
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Country | US
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Telephone | 571-472-3321
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Fax |
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Provider Business Mailing Address
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Address Line | 57 BEAVER ST APT B
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City | ANSONIA
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State | CT
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Zip | 06401-3269
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Country | US
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Telephone | 860-515-1873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101281697
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License Number State | VA
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