Provider Demographics
NPI:1639376494
Name:ESAN, OLUKEMI AYOTUNDE (MB,BS)
Entity Type:Individual
Prefix:DR
First Name:OLUKEMI
Middle Name:AYOTUNDE
Last Name:ESAN
Suffix:
Gender:F
Credentials:MB,BS
Other - Prefix:DR
Other - First Name:OLUKEMI
Other - Middle Name:AYOTUNDE
Other - Last Name:OLOFINBOBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB,BS
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4756
Mailing Address - Country:US
Mailing Address - Phone:412-359-6886
Mailing Address - Fax:412-359-3598
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-359-6886
Practice Address - Fax:412-359-3598
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447481207ZH0000X, 207ZP0102X, 207ZP0102X
WV24099207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102710491Medicaid