Provider Demographics
NPI:1568555258
Name:FASHOKUN, TOLA B (MD)
Entity Type:Individual
Prefix:
First Name:TOLA
Middle Name:B
Last Name:FASHOKUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TOLA
Other - Middle Name:B
Other - Last Name:OMOTOSHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64313
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4313
Mailing Address - Country:US
Mailing Address - Phone:410-550-7802
Mailing Address - Fax:
Practice Address - Street 1:2411 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5228
Practice Address - Country:US
Practice Address - Phone:410-601-2523
Practice Address - Fax:410-601-2524
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD60686207V00000X, 207VF0040X
NMMD2006-0148207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402776100Medicaid
MD402776100Medicaid