Provider Demographics
NPI:1164487955
Name:SOLAJA, MOJIBOLA OLAYINKA (MD)
Entity type:Individual
Prefix:DR
First Name:MOJIBOLA
Middle Name:OLAYINKA
Last Name:SOLAJA
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 1:120 WILDEWOOD PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4300
Mailing Address - Country:US
Mailing Address - Phone:803-788-7882
Mailing Address - Fax:803-788-1828
Practice Address - Street 1:120 WILDEWOOD PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4300
Practice Address - Country:US
Practice Address - Phone:803-788-7882
Practice Address - Fax:803-788-1828
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC215142080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215145Medicaid
SCG42174Medicare UPIN