Provider Demographics
NPI:1649253485
Name:OBADINA, MODUPE OLUWAFUNMILAYO (MD)
Entity type:Individual
Prefix:
First Name:MODUPE
Middle Name:OLUWAFUNMILAYO
Last Name:OBADINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7325 HANOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3618
Mailing Address - Country:US
Mailing Address - Phone:301-345-3966
Mailing Address - Fax:301-982-2937
Practice Address - Street 1:7325 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3618
Practice Address - Country:US
Practice Address - Phone:301-345-3966
Practice Address - Fax:301-982-2937
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0043159207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD282344OtherMDIPA
MD7240130OtherAETNA HEALTHCARE
DCC500-0002OtherCAREFIRST OF DC
MD521863411OtherNCAS
MD52640604OtherCAREFIRST OF MD
MD64757OtherAMERIGROUP
MD190461200Medicaid
MD282344OtherMAMSI HEALTHCARE
MD497106OtherNCPPO
MD100587OtherJOHNS HOPKINS HEALTHCARE
MD521863411OtherCIGNA HEALTHCARE
MDC500-0002OtherBLUE CROSS/BLUE SHIELD
MD0405180OtherUNITED HEALTHCARE
MD282344OtherONENET PPO
MDF46036Medicare UPIN
MD00B731B47Medicare ID - Type Unspecified