Provider Demographics
NPI:1437654316
Name:BOLAJI, OLORUNTOBA (DO)
Entity Type:Individual
Prefix:DR
First Name:OLORUNTOBA
Middle Name:
Last Name:BOLAJI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TOBA
Other - Middle Name:
Other - Last Name:BOLAJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2338 N SMEDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-4412
Mailing Address - Country:US
Mailing Address - Phone:412-538-7604
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-733-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-24
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program