Provider Demographics
NPI:1285668269
Name:BANKOLE, OLUSEGUN BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:OLUSEGUN
Middle Name:BENJAMIN
Last Name:BANKOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8931
Mailing Address - Country:US
Mailing Address - Phone:484-526-3218
Mailing Address - Fax:484-526-3180
Practice Address - Street 1:153 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8931
Practice Address - Country:US
Practice Address - Phone:484-526-3218
Practice Address - Fax:484-526-3180
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240506207R00000X
PAMD447474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine