Provider Demographics
NPI:1083679690
Name:OGUNLADE-ADDAMS, ATINUKE (MD)
Entity Type:Individual
Prefix:DR
First Name:ATINUKE
Middle Name:
Last Name:OGUNLADE-ADDAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1831
Mailing Address - Country:US
Mailing Address - Phone:607-734-1447
Mailing Address - Fax:607-737-6274
Practice Address - Street 1:206 W WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2913
Practice Address - Country:US
Practice Address - Phone:607-857-1095
Practice Address - Fax:607-857-1095
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231915-1174400000X
NY2319152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0584Medicare PIN