Provider Demographics
NPI:1588629240
Name:ODUTOLA, AKINNIYI BABASOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:AKINNIYI
Middle Name:BABASOLA
Last Name:ODUTOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:84 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1618
Mailing Address - Country:US
Mailing Address - Phone:413-241-6152
Mailing Address - Fax:413-241-6153
Practice Address - Street 1:475 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2321
Practice Address - Country:US
Practice Address - Phone:413-241-6152
Practice Address - Fax:413-241-6153
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210668208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA32424OtherPROVIDER HNE #
MA97431403OtherNETWORK HEALTH
2450995OtherUNITED HEALTHCARE #
MA8207136OtherCIGNA
MAMO0497950AOtherCSR NUMBER
210668OtherPROVIDER CONNECTICARE #
3842111OtherAETNA #
MA2159821 / 110080500AMedicaid
692538OtherTUFTS #
MA000000049829OtherBMC HEALTHNET #
MA0030525OtherNEIGHBORHOOD HEALTH PLAN #
MA49849OtherPROVIDER CHILDRENS MEDICAL SECURITY PLAN #
MAJ25872OtherBC/BS NUMBER
MAJ25872OtherBC/BS NUMBER
MA000000049829OtherBMC HEALTHNET #