Provider Demographics
NPI:1992847644
Name:AFOLALU, ABISOLA O (MD)
Entity type:Individual
Prefix:DR
First Name:ABISOLA
Middle Name:O
Last Name:AFOLALU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 S LAMBERT RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3559
Mailing Address - Country:US
Mailing Address - Phone:475-308-1909
Mailing Address - Fax:203-306-3144
Practice Address - Street 1:291 S LAMBERT RD STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3559
Practice Address - Country:US
Practice Address - Phone:475-308-1909
Practice Address - Fax:203-306-3144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001449512Medicaid
CT044951OtherSTATE LICENSE
CT001449512Medicaid