Provider Demographics
NPI:1699734293
Name:ABDULKADIR, TOLANI FAUSAT (MD)
Entity type:Individual
Prefix:
First Name:TOLANI
Middle Name:FAUSAT
Last Name:ABDULKADIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TOLANI
Other - Middle Name:FAUSAT
Other - Last Name:OWOLABI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:815 E PRATT ST STE 209
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4889
Mailing Address - Country:US
Mailing Address - Phone:410-637-5720
Mailing Address - Fax:410-637-5661
Practice Address - Street 1:815 E PRATT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4889
Practice Address - Country:US
Practice Address - Phone:410-637-5720
Practice Address - Fax:410-637-5661
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066959207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416179300Medicaid
PA101329370Medicaid
PA101329370Medicaid