Provider Demographics
NPI:1457391674
Name:FADUGBA, OLAWALE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAWALE
Middle Name:
Last Name:FADUGBA
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 1:423 E WHISPERING LN
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-2917
Mailing Address - Country:US
Mailing Address - Phone:609-748-1247
Mailing Address - Fax:
Practice Address - Street 1:65 JIMMIE LEEDS ROAD
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA AND PERIOPERATIVE MEDICINE
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240
Practice Address - Country:US
Practice Address - Phone:609-748-7597
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8670404Medicaid
NJ051235CULMedicare ID - Type Unspecified
NJ8670404Medicaid