Provider Demographics
NPI:1114309176
Name:ODESANYA, TEMITAYO (MD)
Entity Type:Individual
Prefix:
First Name:TEMITAYO
Middle Name:
Last Name:ODESANYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18414 US HIGHWAY 281 N STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-7611
Mailing Address - Country:US
Mailing Address - Phone:210-495-0224
Mailing Address - Fax:210-495-0343
Practice Address - Street 1:2500 BERNVILLE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:610-378-2000
Practice Address - Fax:610-378-2799
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA303120207R00000X, 208M00000X
TXQ8314207R00000X
PAMD463210207R00000X
MO2017029103208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine