Provider Demographics
NPI:1164873113
Name:OLOWU, ALICIA LEANDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:LEANDRA
Last Name:OLOWU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:LEANDRA
Other - Last Name:BOURNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-7575
Mailing Address - Fax:845-333-7139
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-7575
Practice Address - Fax:845-333-7139
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298392207Q00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program