1770017386 NPI number — DR. OLUSAYO OLUTUNDE FADIRAN MBBS

Table of content: DR. OLUSAYO OLUTUNDE FADIRAN MBBS (NPI 1770017386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770017386 NPI number — DR. OLUSAYO OLUTUNDE FADIRAN MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FADIRAN
Provider First Name:
OLUSAYO
Provider Middle Name:
OLUTUNDE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
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:
1770017386
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2041 GEORGIA AVENUE NW, SUITE 5-C02
Provider Second Line Business Mailing Address:
DEPARTMENT OF MEDICINE, HOWARD UNIVERSITY HOSPITAL
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-865-6620
Provider Business Mailing Address Fax Number:
202-865-4607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FAMILY HEALTHCARE NETWORK
Provider Second Line Business Practice Location Address:
305 EAST CENTER AVENUE
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291-9329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-767-0540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2017

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: 207R00000X , with the licence number:  MD197775 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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