1124096383 NPI number — OLABODE O OGIDAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124096383 NPI number — OLABODE O OGIDAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGIDAN
Provider First Name:
OLABODE
Provider Middle Name:
O
Provider Name Prefix Text:
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:
1124096383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1138 E CHESTNUT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VINELAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08360-5053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-692-1108
Provider Business Mailing Address Fax Number:
856-692-2077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1138 E CHESTNUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VINELAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08360-5053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-692-1108
Provider Business Practice Location Address Fax Number:
856-692-2077
Provider Enumeration Date:
03/14/2006

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: 208000000X , with the licence number:  25MA06442400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 559261 . This is a "BLUE SHIELD OF NEW YORK E" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043195 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1325524 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6976409 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1325524 . This is a "FIRST HEALTH GROUP CORP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4131512 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6976409 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17658 . This is a "UNIVERSITY HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1K7910 . This is a "PHYSICIANS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2699163 . This is a "GROUP HEALTH INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1744624 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5147093 . This is a "AETNA MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: J5528 . This is a "BLUE SHIELD NJ HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 564156 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000203000 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NJ1019 . This is a "BLUE SHIELD OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P402900 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".




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