Provider Demographics
NPI:1275820664
Name:ENILARI, OLADUNNI MODINAT (MD)
Entity Type:Individual
Prefix:
First Name:OLADUNNI
Middle Name:MODINAT
Last Name:ENILARI
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 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12200 WARWICK BLVD STE 290
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-5454
Practice Address - Fax:757-534-5491
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01432208D00000X
VA0101266889207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275820664OtherTRICARE
NC1275820664Medicaid
NC5114141OtherUNITED HEALTHCARE
NCQ0143HOtherSC MEDICAID
VA1275820664OtherVIRGNIA MEDICAID
NC1869QOtherBCBS
VA1275820664OtherVIRGNIA MEDICAID