Provider Demographics
NPI:1932738739
Name:OGUNDIMU, OYINKANSOLA MORENIKE (MD)
Entity Type:Individual
Prefix:
First Name:OYINKANSOLA
Middle Name:MORENIKE
Last Name:OGUNDIMU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 WILLIAN PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668
Mailing Address - Country:US
Mailing Address - Phone:724-733-1414
Mailing Address - Fax:724-327-4505
Practice Address - Street 1:4614 WILLIAN PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668
Practice Address - Country:US
Practice Address - Phone:724-733-1414
Practice Address - Fax:724-327-4505
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD481177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program