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General NPI Number Information
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NPI Number | 1841233541
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Entity Type | Individual
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Provider Name | ADEDAMOLA OMOGBEHIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 110 IRVING STREET NW
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City | WASHINGTON
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State | DC
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Zip | 20010
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Country | US
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Telephone | 202-877-3925
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Fax | 804-355-6031
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Provider Business Mailing Address
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Address Line | 110 IRVING STREET NW
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City | WASHINGTON
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State | DC
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Zip | 20010
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Country | US
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Telephone | 202-877-3925
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Fax | 804-355-6031
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD32344
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 01096353A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD32344
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License Number State | DC
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