Provider Demographics
NPI:1962663328
Name:OWOLABI, TIMOTHY TEMITOPE (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TEMITOPE
Last Name:OWOLABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13403 VOLVO WAY
Mailing Address - Street 2:MEDICAL SUITE
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3810
Mailing Address - Country:US
Mailing Address - Phone:240-500-3764
Mailing Address - Fax:301-790-2050
Practice Address - Street 1:46 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8219
Practice Address - Country:US
Practice Address - Phone:717-532-4148
Practice Address - Fax:717-532-3561
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ37404207Q00000X
PAMD436726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA283716OtherUNISON
PAMD436726OtherLICENSE
PA1007307260034OtherMEDICAID GROUP #
PA102330222 0001Medicaid
PA120420408OtherDEPT OF LABOR
PA25-1716306OtherDEVON
PA25-1716306OtherMULTIPLAN/PHCS
PA251716306OtherMAMSI
PA251716306OtherSOUTH CENTRAL PREFERRED
PA2218823OtherMAMSI
PA251716306OtherINFORMED
PA6950335OtherAETNA HMO
PA867633OtherMEDICARE GROUP #
PA1962663328OtherHEALTH AMERICA
PA251716306OtherDEVON HEALTH
PAU947-0001OtherCAREFIRST DC
PA251716306OtherHEALTHNET/TRICARE
PA25-1716306OtherINTERGROUP
PA50086441OtherCAPITAL BLUECROSS
PA955397-01OtherCAREFIRST MD
PAP00746970OtherRAILROAD MEDICARE
PA25-1716306OtherGREATWEST HEALTHCARE
PA434942OtherHIGHMARK BLUE SHIELD GROUP #
PA9474363OtherAETNA NON-HMO
PAP0010038OtherGATEWAY
PA1962663328OtherFIRST HEALTH
PAOW2128757OtherHIGHMARK BLUESHIELD
PAOW2128757OtherHIGHMARK BLUESHIELD
PAFO0512714OtherDEA