Provider Demographics
NPI:1750563565
Name:OLUDARA-FADARE, OLUBAYO (MD)
Entity type:Individual
Prefix:
First Name:OLUBAYO
Middle Name:
Last Name:OLUDARA-FADARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OLUBAYO
Other - Middle Name:
Other - Last Name:FADARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20768-0837
Mailing Address - Country:US
Mailing Address - Phone:609-213-0237
Mailing Address - Fax:
Practice Address - Street 1:7347 HANOVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3663
Practice Address - Country:US
Practice Address - Phone:301-220-2277
Practice Address - Fax:301-220-4464
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0070459207P00000X, 208D00000X, 207Q00000X
IN01064553A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice