Provider Demographics
NPI:1275779316
Name:OYESANMI, OLUBUSOLA OMOTOKE (DO)
Entity Type:Individual
Prefix:DR
First Name:OLUBUSOLA
Middle Name:OMOTOKE
Last Name:OYESANMI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2722
Mailing Address - Country:US
Mailing Address - Phone:484-463-1541
Mailing Address - Fax:
Practice Address - Street 1:501 N LANSDOWNE AVENUE
Practice Address - Street 2:DELAWARE COUNTY MEMORIAL HOSPITAL
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-284-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016041207P00000X
NJ25MB09096700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine