Provider Demographics
NPI:1740592575
Name:OYETAKIN, PATRICIA AYOOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:AYOOLA
Last Name:OYETAKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:AYOOLA
Other - Last Name:OYETAKIN-WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5730 GLENRIDGE DR STE T100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5747
Mailing Address - Country:US
Mailing Address - Phone:404-939-9220
Mailing Address - Fax:
Practice Address - Street 1:296 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4648
Practice Address - Country:US
Practice Address - Phone:717-812-5050
Practice Address - Fax:717-741-2427
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96680207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103152878Medicaid
PA519615FLTMedicare PIN