Basic Information
| Provider Information | |||||||||
| NPI: | 1528490869 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGUNDE | ||||||||
| FirstName: | BOLANLE | ||||||||
| MiddleName: | OLUWATOYIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 S BISHOP AVE | ||||||||
| Address2: | APT I9 | ||||||||
| City: | SECANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190181971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153271363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 LANSDOWNE AVE | ||||||||
| Address2: | |||||||||
| City: | DARBY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190231200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102374000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2013 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT204041 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2083X0100X | 64188 | TN | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.