Provider Demographics
NPI:1497195259
Name:OLUBOWALE, KATIE CYNTHIA (MD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:CYNTHIA
Last Name:OLUBOWALE
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 1:2195 EUCLID AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3655
Mailing Address - Country:US
Mailing Address - Phone:276-669-5179
Mailing Address - Fax:
Practice Address - Street 1:2195 EUCLID AVE STE 6
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3655
Practice Address - Country:US
Practice Address - Phone:276-669-5179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine