Provider Demographics
NPI:1851439020
Name:MALOMO, OLUSOLA OLUFUNMILOLA (MD)
Entity Type:Individual
Prefix:
First Name:OLUSOLA
Middle Name:OLUFUNMILOLA
Last Name:MALOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUSOLA
Other - Middle Name:OLUFUNMILOLA
Other - Last Name:ODUSOTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:920 VARNUM ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2145
Mailing Address - Country:US
Mailing Address - Phone:202-854-7419
Mailing Address - Fax:
Practice Address - Street 1:920 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2145
Practice Address - Country:US
Practice Address - Phone:202-854-7419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063890207Q00000X
DCMD0368932083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine