Provider Demographics
NPI:1164411237
Name:OSUNDEKO, OLUSOLA (MD, FACE, FACP)
Entity Type:Individual
Prefix:DR
First Name:OLUSOLA
Middle Name:
Last Name:OSUNDEKO
Suffix:
Gender:M
Credentials:MD, FACE, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4093
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:890 POPLAR CHURCH RD
Practice Address - Street 2:503
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2250
Practice Address - Country:US
Practice Address - Phone:717-972-7120
Practice Address - Fax:717-972-7124
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069799L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018444150001Medicaid
PA0018444150001Medicaid