Healthcare Provider Details

I. General information

NPI: 1730117961
Provider Name (Legal Business Name): OLUFUNSHO OLADELE FAMUYIWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 SAINT CHARLES WAY
YORK PA
17402
US

IV. Provider business mailing address

1803 MOUNT ROSE AVE SUITE B3
YORK PA
17403-3026
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-6231
  • Fax: 717-851-5978
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD419550
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: