Provider Demographics
NPI:1720375637
Name:OLAREWAJU, TEMITOPE OLUWATOSIN
Entity Type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:OLUWATOSIN
Last Name:OLAREWAJU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TOPE
Other - Middle Name:
Other - Last Name:ADEBISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-6606
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:4038 WEST RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1842
Practice Address - Country:US
Practice Address - Phone:607-758-3008
Practice Address - Fax:607-758-9515
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY275328207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program