MEDICARE: ISIAKA A BOLARINWA M.D

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	2084P0804X	Child & Adolescent Psychiatry Physician	MA072697	NJ
2	2084P0800X	Psychiatry Physician	MD-073693-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD073693-L	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1467403196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISIAKA A BOLARINWA M.D

Provider Business Mailing Address
First Line	:	822 KLEMM AVE
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1627
Country	:	US
Telephone Number	:	856-282-5566
Fax Number	:	856-396-9917

Provider Business Practice Location Address
First Line	:	822 KLEMM AVE
Second Line	:
City	:	GLOUCESTER CITY
State	:	NJ
Zip	:	08030-1627
Country	:	US
Telephone Number	:	856-282-5566
Fax Number	:	856-396-9917

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/24/2026

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