Provider Demographics
NPI:1609856566
Name:OKELANA, ENIOLA ADEBAYO (MD, FCCP)
Entity Type:Individual
Prefix:DR
First Name:ENIOLA
Middle Name:ADEBAYO
Last Name:OKELANA
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:DR
Other - First Name:BAYO
Other - Middle Name:
Other - Last Name:OKELANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FCCP
Mailing Address - Street 1:9003 WALHALA CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1599
Mailing Address - Country:US
Mailing Address - Phone:804-683-5651
Mailing Address - Fax:804-675-7744
Practice Address - Street 1:433B S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5042
Practice Address - Country:US
Practice Address - Phone:804-732-0248
Practice Address - Fax:804-732-8475
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052627207RP1001X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010195489Medicaid
VA008227E48Medicare ID - Type UnspecifiedMEDICARE
VAG22478Medicare UPIN