Provider Demographics
NPI:1790211365
Name:OBADINA, MOFIYINFOLUWA AYOMIKUN (MD)
Entity Type:Individual
Prefix:
First Name:MOFIYINFOLUWA
Middle Name:AYOMIKUN
Last Name:OBADINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUBURBAN CT APT 3
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3832
Mailing Address - Country:US
Mailing Address - Phone:240-481-1128
Mailing Address - Fax:
Practice Address - Street 1:170 MANNING DRIVE CB#7305
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7141
Practice Address - Country:US
Practice Address - Phone:919-966-1996
Practice Address - Fax:919-966-6735
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302939208000000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program