Provider Demographics
NPI:1295718526
Name:ONABAJO, BOLAJI O (MD)
Entity type:Individual
Prefix:
First Name:BOLAJI
Middle Name:O
Last Name:ONABAJO
Suffix:
Gender:M
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 512650
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19175-2650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-787-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5226OtherBRAVO/ELDER HEALTH
MD5713318OtherCIGNA
MD130441100Medicaid
MD2266876OtherAETNA HMO
MD109200OtherJOHNS HOPKINS HEALTH CARE
MD5384548OtherAETNA PPO
DCF551-0007OtherCARE FIRST BLUE CROSS
MD5384548OtherAETNA PPO