Provider Demographics
NPI:1225328099
Name:OBASANJO, OLUGBENGA O (MBBS MPH PHD FACPM)
Entity Type:Individual
Prefix:DR
First Name:OLUGBENGA
Middle Name:O
Last Name:OBASANJO
Suffix:
Gender:M
Credentials:MBBS MPH PHD FACPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CENTRAL PARK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4954
Mailing Address - Country:US
Mailing Address - Phone:540-322-5930
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTRAL PARK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4954
Practice Address - Country:US
Practice Address - Phone:540-322-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101247970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist