Provider Demographics
NPI:1164664702
Name:MEDSTAT INC
Entity Type:Organization
Organization Name:MEDSTAT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENIOLA
Authorized Official - Middle Name:ADEBAYO
Authorized Official - Last Name:OKELANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FCCP
Authorized Official - Phone:804-732-0248
Mailing Address - Street 1:433B S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5042
Mailing Address - Country:US
Mailing Address - Phone:804-732-0248
Mailing Address - Fax:804-732-8475
Practice Address - Street 1:433B S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5042
Practice Address - Country:US
Practice Address - Phone:804-732-0248
Practice Address - Fax:804-732-8475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052627207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty