Provider Demographics
NPI:1922061878
Name:RENO, OLUYINKA OLOWOLAFE (MD)
Entity Type:Individual
Prefix:MRS
First Name:OLUYINKA
Middle Name:OLOWOLAFE
Last Name:RENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YINKA
Other - Middle Name:ADENIKE
Other - Last Name:OLOWOLAFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-7887
Mailing Address - Fax:508-792-4392
Practice Address - Street 1:65 LIBBY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2949
Practice Address - Country:US
Practice Address - Phone:508-584-6060
Practice Address - Fax:508-584-4949
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230755208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110075448AMedicaid
MA230755OtherLICENSE NUMBER