Individual
OLADUNNI MODINAT ENILARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12200 WARWICK BLVD STE 290, NEWPORT NEWS, VA 23601-2344
(757) 534-5454
(757) 534-5491
Mailing address
856 J CLYDE MORRIS BLVD STE A, NEWPORT NEWS, VA 23601-1318
(757) 316-5800
(757) 534-5190
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
0101266889
VA
208D00000X
General Practice Physician
2014-01432
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275820664
TRICARE
NC
01
—
1275820664
VIRGNIA MEDICAID
VA
05
—
1275820664
—
NC
01
—
1869Q
BCBS
NC
01
—
5114141
UNITED HEALTHCARE
NC
01
—
Q0143H
SC MEDICAID
NC
Enumeration date
07/06/2011
Last updated
08/26/2020
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