Provider Demographics
NPI:1356830442
Name:OLADIPO, OLUWATIMILEHIN
Entity Type:Individual
Prefix:
First Name:OLUWATIMILEHIN
Middle Name:
Last Name:OLADIPO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 DEERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2860
Mailing Address - Country:US
Mailing Address - Phone:717-379-4515
Mailing Address - Fax:717-540-1700
Practice Address - Street 1:4117 DEERFIELD DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2860
Practice Address - Country:US
Practice Address - Phone:717-379-4515
Practice Address - Fax:717-540-1700
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10079409Medicaid