Provider Demographics
NPI:1528490869
Name:OGUNDE, BOLANLE OLUWATOYIN (MD)
Entity type:Individual
Prefix:DR
First Name:BOLANLE
Middle Name:OLUWATOYIN
Last Name:OGUNDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 S BISHOP AVE
Mailing Address - Street 2:APT I9
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-1971
Mailing Address - Country:US
Mailing Address - Phone:215-327-1363
Mailing Address - Fax:
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:610-237-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT204041207R00000X
TN641882083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine