Provider Demographics
NPI:1689982217
Name:BOLORUNDURO, OLUWASEYI BOLAJI (MBBS MPH)
Entity type:Individual
Prefix:DR
First Name:OLUWASEYI
Middle Name:BOLAJI
Last Name:BOLORUNDURO
Suffix:
Gender:M
Credentials:MBBS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 OLD BRIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2383
Mailing Address - Country:US
Mailing Address - Phone:703-492-6822
Mailing Address - Fax:
Practice Address - Street 1:1990 OLD BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2383
Practice Address - Country:US
Practice Address - Phone:703-492-6822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101262310207RI0011X
ARE-8947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine