Provider Demographics
NPI:1013354372
Name:OLAKANPO, OLUSOJI DEREK (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUSOJI
Middle Name:DEREK
Last Name:OLAKANPO
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:GUTHRIE SOUTHERN TIER PEDIATRICS
Mailing Address - Street 2:3344 CHAMBERS RD #200
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-2925
Mailing Address - Country:US
Mailing Address - Phone:607-734-2264
Mailing Address - Fax:
Practice Address - Street 1:3344 CHAMBERS RD STE 100
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-1403
Practice Address - Country:US
Practice Address - Phone:607-734-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD042002208000000X
NH16557208000000X
MDD0076470208000000X
CT052193208000000X
VA0101255475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics