Provider Demographics
NPI:1558686105
Name:OLABINTAN, TOLULOPE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:TOLULOPE
Middle Name:MARY
Last Name:OLABINTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3807 E BROAD ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5623
Mailing Address - Country:US
Mailing Address - Phone:817-717-9597
Mailing Address - Fax:833-992-1938
Practice Address - Street 1:3807 E BROAD ST
Practice Address - Street 2:STE 101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5623
Practice Address - Country:US
Practice Address - Phone:817-717-9597
Practice Address - Fax:833-992-1938
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457440207Q00000X
ARE-9014207Q00000X
TN46111207Q00000X
TXS2445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01720202OtherRR MEDICARE
PA3413140OtherHIGHMARK BLUE SHIELD
PA7064571OtherCIGNA
PA1031193810001Medicaid
PA9797584OtherAETNA
PA605568905OtherPA DEPT OF LABOR
PAP01720202OtherRR MEDICARE