1427065291 NPI number — DR. OJO M OLADIMEJI MD

Table of content: DR. OJO M OLADIMEJI MD (NPI 1427065291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427065291 NPI number — DR. OJO M OLADIMEJI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLADIMEJI
Provider First Name:
OJO
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427065291
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 ASHLEY HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOOSE CREEK
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29445-7109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-572-9270
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 NASSAU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29403-5513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-722-4112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  27042 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 270423 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF5588 . This is a "RR MEDICARE GIN/PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC24946494 . This is a "MEDICARE PIN FETTER HEALTH CARE NETWORK" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP4525 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00789441 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".