Healthcare Provider Details

I. General information

NPI: 1235398488
Provider Name (Legal Business Name): OREOFE ODEJIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

36 S HUNTINGTON AVE APT 16
JAMAICA PLAIN MA
02130-4710
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number246368
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number246368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: