Healthcare Provider Details

I. General information

NPI: 1275152134
Provider Name (Legal Business Name): OGO-OLUWA ONIFADE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HYGEIA DR STE 1420
NEWARK DE
19713-2049
US

IV. Provider business mailing address

200 HYGEIA DR STE 1420
NEWARK DE
19713-2049
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-3017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD483041
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0102910
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC1-0027907
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: