Healthcare Provider Details

I. General information

NPI: 1477900421
Provider Name (Legal Business Name): ODUNAYO ELIZABETH OGUNNAIKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 02/01/2023
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

213 BAKERS CLOSE
NEWTOWN SQUARE PA
19073-5000
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1000
  • Fax:
Mailing address:
  • Phone: 240-464-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD467775
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD467775
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: