Provider Demographics
NPI:1831110519
Name:ALONGE, OLAYINKA FAJANA (MD)
Entity Type:Individual
Prefix:
First Name:OLAYINKA
Middle Name:FAJANA
Last Name:ALONGE
Suffix:
Gender:M
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:PO BOX 98978
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-8978
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:5320 S RAINBOW BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1895
Practice Address - Country:US
Practice Address - Phone:702-944-7105
Practice Address - Fax:702-944-7110
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10604207Q00000X
CAA69293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00948523OtherRAILROAD MEDICARE
NV1831110519Medicaid
NVES395ZMedicare PIN
NVES395X (CQ328B)Medicare PIN
NVES395Y (CQ328A)Medicare PIN