Provider Demographics
NPI:1356523765
Name:OLAYINKA FAJANA ALONGE MD LTD
Entity type:Organization
Organization Name:OLAYINKA FAJANA ALONGE MD LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAYINKA
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALONGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-222-3478
Mailing Address - Street 1:5380 S RAINBOW BLVD
Mailing Address - Street 2:#228
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1877
Mailing Address - Country:US
Mailing Address - Phone:702-222-3478
Mailing Address - Fax:
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:#228
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1877
Practice Address - Country:US
Practice Address - Phone:702-222-3478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV29D1025313291U00000X
NV2000245650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502209Medicaid
NV100506462Medicaid
NVV38267Medicare PIN
NV100502209Medicaid
NVV38266Medicare PIN