Provider Demographics
NPI:1003115387
Name:AGUNBIADE, TOLULOPE ADESIYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:TOLULOPE
Middle Name:ADESIYUN
Last Name:AGUNBIADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TOLULOPE
Other - Middle Name:ADEBISI
Other - Last Name:ADESIYUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:
Practice Address - Street 1:1 BRACE RD STE C2
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2600
Practice Address - Country:US
Practice Address - Phone:856-482-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDFA5309504207RC0000X, 207RA0001X
NJ25MA11567700207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease