Provider Demographics
NPI:1770017386
Name:FADIRAN, OLUSAYO OLUTUNDE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:OLUSAYO
Middle Name:OLUTUNDE
Last Name:FADIRAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA AVENUE NW, SUITE 5-C02
Mailing Address - Street 2:DEPARTMENT OF MEDICINE, HOWARD UNIVERSITY HOSPITAL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060
Mailing Address - Country:US
Mailing Address - Phone:202-865-6620
Mailing Address - Fax:202-865-4607
Practice Address - Street 1:FAMILY HEALTHCARE NETWORK
Practice Address - Street 2:305 EAST CENTER AVENUE
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-9329
Practice Address - Country:US
Practice Address - Phone:844-767-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD197775207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine