Provider Demographics
NPI:1952872822
Name:OBILANA, OLAMIDE
Entity Type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:
Last Name:OBILANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SHILLING AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3268
Mailing Address - Country:US
Mailing Address - Phone:267-324-9744
Mailing Address - Fax:
Practice Address - Street 1:114 SHILLING AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3268
Practice Address - Country:US
Practice Address - Phone:267-324-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA38793601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care