Provider Demographics
NPI:1477849628
Name:OBAKPOLOR, OSAHON JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAHON
Middle Name:JOHN
Last Name:OBAKPOLOR
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 1:4727 FRIENDSHIP AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1778
Mailing Address - Country:US
Mailing Address - Phone:412-235-5810
Mailing Address - Fax:412-235-5890
Practice Address - Street 1:4727 FRIENDSHIP AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1778
Practice Address - Country:US
Practice Address - Phone:412-235-5810
Practice Address - Fax:412-235-5890
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452334207Q00000X, 207QG0300X
TXU3970207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103054062Medicaid
13593382OtherCAQH