Basic Information
| Provider Information | |||||||||
| NPI: | 1912017690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLUWEHINMI | ||||||||
| FirstName: | FOLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | FAWEHINMI | ||||||||
| OtherFirstName: | FOLA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3022 WILLIAMS DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035739800 | ||||||||
| FaxNumber: | 7035732959 | ||||||||
| Practice Location | |||||||||
| Address1: | 3022 WILLIAMS DR STE 300 | ||||||||
| Address2: | INTERNAL MEDICINE/GERIATRICS | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035739800 | ||||||||
| FaxNumber: | 7035732959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 10/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 0101253418 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.