Provider Demographics
NPI:1306428172
Name:SALAKO, OLUGBENGA AYOOLUWA (MBCHB)
Entity type:Individual
Prefix:DR
First Name:OLUGBENGA
Middle Name:AYOOLUWA
Last Name:SALAKO
Suffix:
Gender:M
Credentials:MBCHB
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 415348 MLK 13-106
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:291 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3643
Practice Address - Country:US
Practice Address - Phone:508-334-8409
Practice Address - Fax:508-334-8408
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-08-16
Deactivation Date:2022-02-24
Deactivation Code:
Reactivation Date:2022-03-14
Provider Licenses
StateLicense IDTaxonomies
MA1019115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine