Healthcare Provider Details

I. General information

NPI: 1508353004
Provider Name (Legal Business Name): OMOBOLA ONIKOYI DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PITTSFIELD RD STE 12C
LENOX MA
01240-2185
US

IV. Provider business mailing address

55 PITTSFIELD RD STE 12C
LENOX MA
01240-2185
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-4679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number1028335
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: