1225658974 NPI number — OLUWATOMIWA OLAWALE BABADE MBBD

Table of content: OLUWATOMIWA OLAWALE BABADE MBBD (NPI 1225658974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225658974 NPI number — OLUWATOMIWA OLAWALE BABADE MBBD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BABADE
Provider First Name:
OLUWATOMIWA
Provider Middle Name:
OLAWALE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225658974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 SE 10TH ST UNIT 1017
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98058-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-246-2121
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2017 JEFFERSON ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24014-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-266-6961
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)