Provider Demographics
NPI:1639949548
Name:OBASUN, OLUFEMI S (PHD)
Entity Type:Individual
Prefix:DR
First Name:OLUFEMI
Middle Name:S
Last Name:OBASUN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FEMI
Other - Middle Name:S
Other - Last Name:OBASUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, DBA
Mailing Address - Street 1:7007 BACKLICK CT STE 250USA
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3937
Mailing Address - Country:US
Mailing Address - Phone:703-214-9666
Mailing Address - Fax:
Practice Address - Street 1:7007 BACKLICK CT STE 250USA
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3937
Practice Address - Country:US
Practice Address - Phone:703-214-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABLA-0000002407374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide