Healthcare Provider Details

I. General information

NPI: 1730146705
Provider Name (Legal Business Name): OMOLARA Y DAIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OMOLARA YEWANDE ADEGBITE MD

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4335 W. DUBLIN - GRANVILLE RD.
DUBLIN OH
43017
US

IV. Provider business mailing address

4335 W. DUBLIN - GRANVILLE RD
DUBLIN OH
43017
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-7772
  • Fax: 614-764-0843
Mailing address:
  • Phone: 614-889-7772
  • Fax: 614-764-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35078015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: