Provider Demographics
NPI:1497750277
Name:BOLAJI, OLUBUKOLA DAVID (MD)
Entity Type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:DAVID
Last Name:BOLAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 GUNSTON PLZ UNIT 1164
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22199-8054
Mailing Address - Country:US
Mailing Address - Phone:817-773-7014
Mailing Address - Fax:844-373-1885
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4418
Practice Address - Country:US
Practice Address - Phone:703-396-5292
Practice Address - Fax:703-396-5297
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3919207R00000X
VA0101261217207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5461151OtherAETNA
TX8P5794OtherBCBS
TX180925301Medicaid
OH0284562Medicaid
OH0284562Medicaid
TX8G6277Medicare PIN