Provider Demographics
NPI:1265688287
Name:OLUGBADE-OSEYEMI, CECILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:OLUGBADE-OSEYEMI
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 1:208 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1822
Mailing Address - Country:US
Mailing Address - Phone:610-668-4014
Mailing Address - Fax:
Practice Address - Street 1:208 UPLAND RD
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1822
Practice Address - Country:US
Practice Address - Phone:610-668-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT186227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine