Provider Demographics
NPI:1962463398
Name:AYOOLA, EPHRAIM AYOBANJI (MD)
Entity Type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:AYOBANJI
Last Name:AYOOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-367-5808
Mailing Address - Fax:302-526-4238
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE #300
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-741-0204
Practice Address - Fax:302-674-5874
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000041565Medicaid
DE1000041565Medicaid
DEI60987Medicare UPIN