Provider Demographics
NPI:1962637645
Name:ALO, OLUBUNMI ASHABI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUBUNMI
Middle Name:ASHABI
Last Name:ALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51827
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0031
Mailing Address - Country:US
Mailing Address - Phone:843-353-2111
Mailing Address - Fax:843-628-4326
Practice Address - Street 1:3864 RENEE DRIVE
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-353-2111
Practice Address - Fax:843-628-4326
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32378207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP9634Medicaid