Provider Demographics
NPI:1144518481
Name:OLLA, OLUBUKOLA OPEYEMI (MD)
Entity type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:OPEYEMI
Last Name:OLLA
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 1:401 SOUTH 16TH STREET
Mailing Address - Street 2:APT 4F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1661
Mailing Address - Country:US
Mailing Address - Phone:201-407-8764
Mailing Address - Fax:
Practice Address - Street 1:401 S 16TH ST
Practice Address - Street 2:APT 4F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1661
Practice Address - Country:US
Practice Address - Phone:201-407-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT200404207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology