Provider Demographics
NPI:1427344175
Name:OLUGBILE, SOPE OMOWALE (MD)
Entity type:Individual
Prefix:
First Name:SOPE
Middle Name:OMOWALE
Last Name:OLUGBILE
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 1:85 RETREAT STREET
Mailing Address - Street 2:HARTFORD HOSPITAL CANCER CENTER
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2555
Mailing Address - Country:US
Mailing Address - Phone:860-249-6291
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0918
Practice Address - Country:US
Practice Address - Phone:404-425-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT064042207RH0000X, 207RH0003X, 207RX0202X
OH35.130693207RX0202X
GA101581207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology