Healthcare Provider Details

I. General information

NPI: 1235495268
Provider Name (Legal Business Name): ADEBUKOLA MUJDAT OGUNDOYIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADEBUKOLA ADETORO

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N 21ST ST
CAMP HILL PA
17011-2204
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 717-972-4448
  • Fax: 717-972-7366
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD455324
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD455324
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: