Provider Demographics
NPI:1619402021
Name:BARUWA ETTI, ABISOLA GBEMISOLA
Entity type:Individual
Prefix:
First Name:ABISOLA
Middle Name:GBEMISOLA
Last Name:BARUWA ETTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABISOLA
Other - Middle Name:GBEMISOLA
Other - Last Name:ALUKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:VCUHS GME ADMINISTRATION
Mailing Address - Street 2:BOX 980257
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0257
Mailing Address - Country:US
Mailing Address - Phone:804-828-9783
Mailing Address - Fax:
Practice Address - Street 1:1001 E LEIGH ST FL 4
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5004
Practice Address - Country:US
Practice Address - Phone:804-828-7999
Practice Address - Fax:804-828-5941
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101278900207RH0003X
CT064925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology