Provider Demographics
NPI:1760989628
Name:ATANDA, OLUWAFUNMILAYO IFEOLU (MD)
Entity Type:Individual
Prefix:
First Name:OLUWAFUNMILAYO
Middle Name:IFEOLU
Last Name:ATANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUWAFUNMILAYO
Other - Middle Name:IFEOLU
Other - Last Name:ATANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 ROLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4011
Mailing Address - Country:US
Mailing Address - Phone:240-615-7667
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVENUE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059-0001
Practice Address - Country:US
Practice Address - Phone:202-865-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101277867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program