Provider Demographics
NPI:1659552156
Name:OLUMUYIWA OJEDIRAN, M.D P.C
Entity Type:Organization
Organization Name:OLUMUYIWA OJEDIRAN, M.D P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUMUYIWA
Authorized Official - Middle Name:AKINNIYI
Authorized Official - Last Name:OJEDIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-733-0111
Mailing Address - Street 1:734 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5817
Mailing Address - Country:US
Mailing Address - Phone:804-733-0111
Mailing Address - Fax:804-733-1176
Practice Address - Street 1:734 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5817
Practice Address - Country:US
Practice Address - Phone:804-733-0111
Practice Address - Fax:804-733-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233648207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA465753OtherBLUE CROSS
VAH90675Medicare UPIN
VACO8771Medicare PIN