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1497750277

NPI Code Detail

MEDICARE: OLUBUKOLA DAVID BOLAJI MD

MEDICARE: OLUBUKOLA DAVID BOLAJI 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	M3919	TX
2	207R00000X	Internal Medicine Physician	0101261217	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5461151	OTHER	TX	AETNA
2	8P5794	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497750277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUBUKOLA DAVID BOLAJI MD

Provider Business Mailing Address
First Line	:	7726 GUNSTON PLZ UNIT 1164
Second Line	:
City	:	LORTON
State	:	VA
Zip	:	22199-8054
Country	:	US
Telephone Number	:	817-773-7014
Fax Number	:	844-373-1885

Provider Business Practice Location Address
First Line	:	8700 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4418
Country	:	US
Telephone Number	:	703-396-5292
Fax Number	:	703-396-5297

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/18/2023

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Directions to “ OLUBUKOLA DAVID BOLAJI MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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