Provider Demographics
NPI:1336451590
Name:WERT, OLUSEUN OLUMIDE (DO)
Entity Type:Individual
Prefix:
First Name:OLUSEUN
Middle Name:OLUMIDE
Last Name:WERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 SAW MILL RUN BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-2720
Mailing Address - Country:US
Mailing Address - Phone:412-884-0327
Mailing Address - Fax:412-884-0328
Practice Address - Street 1:3516 SAW MILL RUN BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-2720
Practice Address - Country:US
Practice Address - Phone:412-884-0327
Practice Address - Fax:412-884-0328
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016482207QS0010X
NJ25MB09317300207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine