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General NPI Number Information
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NPI Number | 1801243621
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Entity Type | Individual
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Provider Name | IBILOLA ADEKUNLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2016
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 2041 GEORGIA AVENUE NW TOWER 4300
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City | WASHINGTON
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State | DC
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Zip | 20060-1458
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Country | US
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Telephone | 202-865-1670
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Fax | 240-348-8572
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Provider Business Mailing Address
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Address Line | 2041 GEORGIA AVENUE NW TOWER 4300
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City | WASHINGTON
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State | DC
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Zip | 20060-0001
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | D95117
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License Number State | MD
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