Provider Demographics
NPI:1295879005
Name:FAMAKIN, BOLANLE M (MD)
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:M
Last Name:FAMAKIN
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:NATIONAL INSTITUTES OF HEALTH
Mailing Address - Street 2:NINDS, STROKE BRANCH, BUILDING 49, MSC 4476
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-402-6936
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL INSTITUTES OF HEALTH
Practice Address - Street 2:NINDS, STROKE BRANCH, BUILDING 49, MSC 4476
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-402-6936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0548762084V0102X
MDD633442084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology