Provider Demographics
NPI:1508434481
Name:OLA, OLUWABUSOLA IGBEKELEOLUWA
Entity type:Individual
Prefix:
First Name:OLUWABUSOLA
Middle Name:IGBEKELEOLUWA
Last Name:OLA
Suffix:
Gender:F
Credentials:
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 KEE LN STE 200
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7463
Practice Address - Country:US
Practice Address - Phone:704-316-2319
Practice Address - Fax:704-316-2321
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-02500207V00000X
PAMT224055390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program