Provider Demographics
NPI:1376991869
Name:OLUBIYI, OLUTAYO IBUKUNOLU (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:OLUTAYO
Middle Name:IBUKUNOLU
Last Name:OLUBIYI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N PARHAM RD STE 315
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4424
Mailing Address - Country:US
Mailing Address - Phone:804-288-8327
Mailing Address - Fax:804-282-3744
Practice Address - Street 1:2810 N PARHAM RD STE 315
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4424
Practice Address - Country:US
Practice Address - Phone:804-288-8327
Practice Address - Fax:804-282-3744
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-020672085N0700X, 2085R0202X
PAMD4691632085R0202X
PAMT211009390200000X
VA01012746992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program