Provider Demographics
NPI:1689990574
Name:ODUNMBAKU, ABISOLA (MD)
Entity Type:Individual
Prefix:
First Name:ABISOLA
Middle Name:
Last Name:ODUNMBAKU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ABISOLA
Other - Middle Name:
Other - Last Name:ODUNMBAKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 W DIAMOND AVE
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1419
Mailing Address - Country:US
Mailing Address - Phone:301-315-3826
Mailing Address - Fax:
Practice Address - Street 1:12008 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1985
Practice Address - Country:US
Practice Address - Phone:301-762-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD794402085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty