MEDICARE: OLASUPO ADEWALE ODUNSI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0052125	MD

General Provider Information

NPI Number	:	1306814033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLASUPO ADEWALE ODUNSI MD

Provider Business Mailing Address
First Line	:	7513 NEW HAMPSHIRE AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6969
Country	:	US
Telephone Number	:	301-434-0075
Fax Number	:	301-434-0151

Provider Business Practice Location Address
First Line	:	7513 NEW HAMPSHIRE AVE
Second Line	:
City	:	TAKOMA PARK
State	:	MD
Zip	:	20912-6969
Country	:	US
Telephone Number	:	301-434-0075
Fax Number	:	301-434-0151

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/12/2011

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