Provider Demographics
NPI:1427497320
Name:OGUNDIPE, FUNMILOLA TITILAYO (MD)
Entity type:Individual
Prefix:DR
First Name:FUNMILOLA
Middle Name:TITILAYO
Last Name:OGUNDIPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FUNMILOLA
Other - Middle Name:TITILAYO
Other - Last Name:ADEYEMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 SENTARA CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5713
Mailing Address - Country:US
Mailing Address - Phone:757-984-7218
Mailing Address - Fax:
Practice Address - Street 1:100 SENTARA CIR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5713
Practice Address - Country:US
Practice Address - Phone:757-984-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD458421208M00000X
DCMD045157390200000X
VA0101269618207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program