Provider Demographics
NPI:1407838550
Name:APOESO, OLUSEGUN A (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSEGUN
Middle Name:A
Last Name:APOESO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 ABRAHAMS BOULEVARD
Mailing Address - Street 2:HEBREW HOME HOSPITAL
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-3949
Mailing Address - Country:US
Mailing Address - Phone:860-523-3854
Mailing Address - Fax:860-523-3828
Practice Address - Street 1:1 ABRAHAMS BOULEVARD
Practice Address - Street 2:HEBREW HOME HOSPITAL
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-3949
Practice Address - Country:US
Practice Address - Phone:860-523-3800
Practice Address - Fax:860-523-3949
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036837207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001368374Medicaid
CT010036837C701OtherBC
CT001368374Medicaid
G78313Medicare UPIN
CT110007305Medicare ID - Type Unspecified