Healthcare Provider Details

I. General information

NPI: 1457035198
Provider Name (Legal Business Name): IBRAHIM BAYO AMEEN-IKOYI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S MAIN ST
DANVILLE VA
24541-2927
US

IV. Provider business mailing address

201 S MAIN ST
DANVILLE VA
24541-2927
US

V. Phone/Fax

Practice location:
  • Phone: 484-258-5580
  • Fax:
Mailing address:
  • Phone: 484-258-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101288711
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: