Provider Demographics
NPI:1760611511
Name:FADUGBA, OLAJUMOKE OLANREWAJU (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAJUMOKE
Middle Name:OLANREWAJU
Last Name:FADUGBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUMY
Other - Middle Name:O
Other - Last Name:FADUGBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER
Mailing Address - Street 2:WEST PAVILLION 1ST FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-3202
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER
Practice Address - Street 2:WEST PAVILLION 1ST FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451448207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine