Healthcare Provider Details

I. General information

NPI: 1144917105
Provider Name (Legal Business Name): OLAMIDE OLOWOYO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OLAMIDE OLUTOSIN OYEKUNLE

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
LEWISBURG PA
17837-9350
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 570-522-4264
  • Fax: 570-768-3709
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD488760
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: