Provider Demographics
NPI:1568024685
Name:ODETOLA, OLAYINKA OLUBUKOLA (MD)
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:OLUBUKOLA
Last Name:ODETOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY, DEPT OF PEDIATRICS
Mailing Address - Street 2:ROOM 6B23
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5317
Mailing Address - Country:US
Mailing Address - Phone:718-963-7956
Mailing Address - Fax:718-963-7957
Practice Address - Street 1:760 BROADWAY, DEPT OF PEDIATRICS
Practice Address - Street 2:ROOM 6B23
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-7956
Practice Address - Fax:718-963-7957
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program