1144917105 NPI number — OLAMIDE OLOWOYO

Table of content: OLAMIDE OLOWOYO (NPI 1144917105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144917105 NPI number — OLAMIDE OLOWOYO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLOWOYO
Provider First Name:
OLAMIDE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OYEKUNLE
Provider Other First Name:
OLAMIDE
Provider Other Middle Name:
OLUTOSIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144917105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NEPHROLOGY FELLOWSHIP, GEISINGER MEDICAL CENTER
Provider Second Line Business Mailing Address:
100 N ACADEMY AVE
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-274-1718
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GEISINGER MEDICAL CENTER
Provider Second Line Business Practice Location Address:
100 N ACADEMY AVE
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-274-1718
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MT228158 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com