Provider Demographics
NPI:1306041652
Name:MALOMO, OLUTOYIN MODUPE (MD)
Entity Type:Individual
Prefix:
First Name:OLUTOYIN
Middle Name:MODUPE
Last Name:MALOMO
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 1:1600 ELMWOOD AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3862
Mailing Address - Country:US
Mailing Address - Phone:585-672-1322
Mailing Address - Fax:
Practice Address - Street 1:1800 ENGLISH RD
Practice Address - Street 2:SUITE 10
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1691
Practice Address - Country:US
Practice Address - Phone:585-225-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253647-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics