Provider Demographics
NPI:1326838186
Name:BOLARINWA, OLADUNNI O
Entity type:Individual
Prefix:
First Name:OLADUNNI
Middle Name:O
Last Name:BOLARINWA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15615 BIRCH RUN TER
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3583
Mailing Address - Country:US
Mailing Address - Phone:240-765-4179
Mailing Address - Fax:
Practice Address - Street 1:15615 BIRCH RUN TER
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3583
Practice Address - Country:US
Practice Address - Phone:240-765-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health