Provider Demographics
NPI:1629099288
Name:DADA, BOLANLE (MD)
Entity Type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:DADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BOLANLE
Other - Middle Name:
Other - Last Name:OLUDEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1068
Mailing Address - Country:US
Mailing Address - Phone:610-261-0270
Mailing Address - Fax:
Practice Address - Street 1:700 E NORWEGIAN ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2710
Practice Address - Country:US
Practice Address - Phone:610-261-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine