Provider Demographics
NPI:1174926679
Name:OGBONLOWO, OLUFUNMILOLA MODUPE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUFUNMILOLA
Middle Name:MODUPE
Last Name:OGBONLOWO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:19465 DEERFIELD AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1705
Mailing Address - Country:US
Mailing Address - Phone:571-293-2424
Mailing Address - Fax:972-947-5370
Practice Address - Street 1:19465 DEERFIELD AVE STE 309
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-1705
Practice Address - Country:US
Practice Address - Phone:571-293-2424
Practice Address - Fax:972-947-5370
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2021-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101263837207Q00000X
VA10421511174N00000X
MI4301107153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174N00000XOther Service ProvidersLactation Consultant, Non-RN