Provider Demographics
NPI:1497217061
Name:OLADELE, GBOLA J (NP)
Entity Type:Individual
Prefix:MR
First Name:GBOLA
Middle Name:J
Last Name:OLADELE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 EAGER TER
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-7345
Mailing Address - Country:US
Mailing Address - Phone:240-988-5654
Mailing Address - Fax:
Practice Address - Street 1:4 ATLANTIC ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2350
Practice Address - Country:US
Practice Address - Phone:202-540-9857
Practice Address - Fax:202-232-8494
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health