Healthcare Provider Details

I. General information

NPI: 1881154904
Provider Name (Legal Business Name): OMOWUNMI OLUWO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CETRONIA RD STE 205N
ALLENTOWN PA
18104-9263
US

IV. Provider business mailing address

240 CETRONIA RD STE 205N
ALLENTOWN PA
18104-9263
US

V. Phone/Fax

Practice location:
  • Phone: 484-426-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR78057
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA12863400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD491224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: