Provider Demographics
NPI:1033544135
Name:OMOTOYE, SAMUEL (MD, FRCPC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:OMOTOYE
Suffix:
Gender:M
Credentials:MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2148
Mailing Address - Country:US
Mailing Address - Phone:434-200-2712
Mailing Address - Fax:434-200-2851
Practice Address - Street 1:2410 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2148
Practice Address - Country:US
Practice Address - Phone:434-200-2712
Practice Address - Fax:434-200-2851
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-07
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120322207R00000X, 207RC0000X, 207RC0001X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access