Provider Demographics
NPI:1730117961
Name:FAMUYIWA, OLUFUNSHO OLADELE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUFUNSHO
Middle Name:OLADELE
Last Name:FAMUYIWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:292 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-851-6231
Practice Address - Fax:717-851-5978
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD419550207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03253001OtherCAPITAL BLUE CROSS-WMG
PA104612OtherJOHNS HOPKINS
PA136309OtherUNISON-WMG
PA1404335OtherHIGHMARK BLUE SHIELD
PA1530147OtherGATEWAY-WMG
PA367128OtherMAMSI-WMG
PA20017690OtherAMERIHEALTH MERCY-WMG
PA83883OtherGEISINGER
PA001902831Medicaid
MD615820OtherCAREFIRST MD BCBS
PA7673463OtherAETNA
PA7673463OtherAETNA
PA20017690OtherAMERIHEALTH MERCY-WMG
PA83883OtherGEISINGER