Provider Demographics
NPI:1225658974
Name:BABADE, OLUWATOMIWA OLAWALE (MBBD)
Entity Type:Individual
Prefix:
First Name:OLUWATOMIWA
Middle Name:OLAWALE
Last Name:BABADE
Suffix:
Gender:M
Credentials:MBBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 SE 10TH ST UNIT 1017
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-4404
Mailing Address - Country:US
Mailing Address - Phone:425-246-2121
Mailing Address - Fax:
Practice Address - Street 1:2017 JEFFERSON ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2419
Practice Address - Country:US
Practice Address - Phone:540-266-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program