Healthcare Provider Details

I. General information

NPI: 1477849628
Provider Name (Legal Business Name): OSAHON JOHN OBAKPOLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 FRIENDSHIP AVE STE 200
PITTSBURGH PA
15224-1778
US

IV. Provider business mailing address

4727 FRIENDSHIP AVE STE 200
PITTSBURGH PA
15224-1778
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-5810
  • Fax: 412-235-5890
Mailing address:
  • Phone: 412-235-5810
  • Fax: 412-235-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD452334
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberU3970
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD452334
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberU3970
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: