Basic Information
| Provider Information | |||||||||
| NPI: | 1285798843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPOOLA | ||||||||
| FirstName: | ADEBOWALE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 WOOD HILL RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208508724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016108306 | ||||||||
| FaxNumber: | 3013092596 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 WOOD HILL RD | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208508724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016108306 | ||||||||
| FaxNumber: | 3013092596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | D0062845 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | D0062845 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 410436600 | 05 | MD | MEDICAID |