Provider Demographics
NPI:1053676866
Name:BABALOLA, OLUWASEUN (MD)
Entity Type:Individual
Prefix:
First Name:OLUWASEUN
Middle Name:
Last Name:BABALOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7253 AMBASSADOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2710
Mailing Address - Country:US
Mailing Address - Phone:443-436-1221
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:1600 CRAIN HWY S STE 101
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6440
Practice Address - Country:US
Practice Address - Phone:410-918-3200
Practice Address - Fax:410-918-3425
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD831772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD121539600Medicaid