Provider Demographics
NPI:1326472564
Name:ODUSOLA, OLADIPO EMMANUEL
Entity Type:Individual
Prefix:
First Name:OLADIPO
Middle Name:EMMANUEL
Last Name:ODUSOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 PYRAMID AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2855
Mailing Address - Country:US
Mailing Address - Phone:412-251-7108
Mailing Address - Fax:
Practice Address - Street 1:3045 PYRAMID AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-2855
Practice Address - Country:US
Practice Address - Phone:412-251-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA39390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program