Provider Demographics
NPI:1992830509
Name:AKINBAMOWO, AYOOLA O (MD)
Entity Type:Individual
Prefix:DR
First Name:AYOOLA
Middle Name:O
Last Name:AKINBAMOWO
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2760
Mailing Address - Fax:717-359-9427
Practice Address - Street 1:3130 GRANDVIEW RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-9134
Practice Address - Country:US
Practice Address - Phone:717-339-2760
Practice Address - Fax:717-630-1120
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433854207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1575953OtherGATEWAY-WMG
PA210883OtherJOHNS HOPKINS
PA50078661OtherCAPITAL BLUE CROSS-WMG
PA102151517Medicaid
MD933062OtherCAREFIRST MD BCBS
PA20078633OtherAMERIHEALTH MERCY-WMG
PA243645OtherUNISON-WMG
PA2058519OtherHIGHMARK BLUE SHIELD
PA9374251OtherAETNA
PA120279OtherGEISINGER HEALTH PLAN
PA9374251OtherAETNA
PA20078633OtherAMERIHEALTH MERCY-WMG