Provider Demographics
NPI:1972747533
Name:SOMORIN, OLUWASEUN EKUNDAYO (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUWASEUN
Middle Name:EKUNDAYO
Last Name:SOMORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:OLUWASEUN
Other - Middle Name:E
Other - Last Name:SOMORIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1900 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7474
Mailing Address - Country:US
Mailing Address - Phone:540-776-4000
Mailing Address - Fax:540-776-2083
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-776-4000
Practice Address - Fax:540-776-2083
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245493208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972747533Medicaid
VAP00736593Medicare PIN
VA020529S90Medicare PIN